Hoskins, SJ; (2014) Monitoring the treatment and health of patients accessing HIV care in low and middle-income countries. Doctoral thesis , UCL (University College London).

Preview

Text Hoskins, S. THESIS.pdf.redacted.pdf Download (2MB) | Preview

Abstract

Monitoring patient health in low and middle-income country HIV care programmes is challenging, as, without evidence, measurement tools derived from high-income country studies have been adapted and paper-based monitoring systems quickly developed. An accurate understanding of the population in care may be compromised. This thesis examines aspects of HIV care: access to Cotrimoxazole preventive therapy (CPT), prevalence of common mental disorders (CMD), and tools used to measure outcomes on antiretroviral therapy (ART). CPT access is frequently cited as being as low as 4% with few studies estimating long-term access. Estimated prevalence of CMD varies widely as little standardisation in measurement tools exists. And, while international ART programme monitoring recommendations exist, no study has compared the concordance, or otherwise, between information collected in different countries. The first study in this thesis, in Ugandan and Tanzanian patients, estimates time from HIV diagnosis to CPT initiation, time spent on CPT and associated factors. These estimates are compared to reported data. CPT coverage and time on CPT were poor. The absence of unique patient identifiers means monitoring data cannot distinguish patients who were diagnosed and initiate CPT in different reporting periods. Furthermore, no long-term data are officially reported. The second study estimates CMD prevalence and associated factors among HIV-positive Ugandans, and validates measurement tools for this. Prevalence was around 10% but no routinely-collected data identified at-risk patients. Measurement tool validity was poor, and their use substantially overestimates prevalence. The third study compares ART programme monitoring systems in Malawi, Uganda, Ukraine and Tanzania. There was little concordance with international recommendations, and discordance in additional data-items and paediatric age-groupings. This signalled a lack of understanding of how best to monitor the health of treated populations. Finally, a fourth study is proposed with the aim of assessing the validity and predictive value of existing programmatic monitoring systems.

Download activity - last month

Export as CSVXMLJSON

Download activity - last 12 months

Export as CSVXMLJSON

Downloads by country - last 12 months

Export as JSONXMLCSV

Archive Staff Only

View Item