Browsing by Author "Coutinho, Alex"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    A Cluster-Randomised Trial to Compare Home-Based with Health Facility- Based Antiretroviral Treatment in Uganda: Study Design and Baseline Findings
    (Bentham Science Publishers Ltd., 2007) Amuron, Barbara; Coutinho, Alex; Grosskurth, Heiner; Nabiryo, Christine; Birungi, Josephine; Namara, Geoffrey; Levin, Jonathan; Smith, Peter G.; Jaffar, Shabbar
    The scale-up of antiretroviral therapy is progressing rapidly in Africa but with a limited evidence-base. We re- port the baseline results from a large pragmatic cluster-randomised trial comparing different strategies of ART delivery. The trial is integrated in normal health service delivery. 1453 subjects were recruited into the study. Significantly more women (71%) than men (29%) were recruited. The WHO HIV clinical stage at presentation did not differ significantly between men and women: 58% and 53% respectively were at WHO stage III or IV (p=0.9). Median CD4 counts (IQR) x 10 6 cells/l were 98 (28, 160) among men and 111 (36, 166) among women. Sixty-four percent of women and 61% men had plasma viral load 100,000 copies. Baseline characteris- tics did not change over time. Considerably fewer men than women presented for treatment.
  • Thumbnail Image
    Item
    The Costs And Effectiveness Of Four HIV Counseling And Testing Strategies In Uganda
    (Aids, 2009) Menzies, Nick; Abang, Betty; Wanyenze, Rhoda; Nuwaha, Fred; Mugisha, Balaam; Coutinho, Alex; Bunnell, Rebecca; Mermin, Jonathan; Blandford, John M.
    HIV counseling and testing (HCT) is a key intervention for HIV/AIDS control, and new strategies have been developed for expanding coverage in developing countries. We compared costs and outcomes of four HCT strategies in Uganda.A retrospective cohort of 84 323 individuals received HCT at one of four Ugandan HCT programs between June 2003 and September 2005. HCT strategies assessed were stand-alone HCT; hospital-based HCT; household-member HCT; and door-to-door HCT.We collected data on client volume, demographics, prior testing and HIV diagnosis from project monitoring systems, and cost data from project accounts and personnel interviews. Strategies were compared in terms of costs and effectiveness at reaching key population groups.Household-member and door-to-door HCT strategies reached the largest proportion of previously untested individuals (>90% of all clients). Hospital-based HCT diagnosed the greatest proportion of HIV-infected individuals (27% prevalence), followed by stand-alone HCT (19%). Household-member HCT identified the highest percentage of discordant couples; however, this was a small fraction of total clients (<4%). Costs per client (2007 USD) were $19.26 for stand-alone HCT, $11.68 for hospital-based HCT, $13.85 for household-member HCT, and $8.29 for door-to-door-HCT.All testing strategies had relatively low per client costs. Hospital-based HCT most readily identified HIV-infected individuals eligible for treatment, whereas home-based strategies more efficiently reached populations with low rates of prior testing and HIV-infected people with higher CD4 cell counts. Multiple HCT strategies with different costs and efficiencies can be used to meet the UNAIDS/WHO call for universal HCT access by 2010.
  • Thumbnail Image
    Item
    Scale-up of antiretroviral therapy in sub-Saharan Africa – priorities for public health research
    (Tropical Medicine and International Health, 2007) Jaffar, Shabbar; Mbidde, Edward; Robb, Alistair; Coutinho, Alex; Muwanga, Moses; Obermeyer, Carla Makhlouf; Weller, Ian; Hart, Graham; Smith, Peter G.; Haines, Andy; Grosskurth, Heiner
    The scale-up of antiretroviral therapy (ART) in Africa is the largest health delivery programme ever contemplated on the continent. About 1.3 million people are now on ART and a further 3.5 million are estimated to be in current need of ART. Research is required urgently to identify strategies of scaling-up ART delivery to ensure that it has high coverage, is effective and is available equitably. Furthermore, the number of new infections occurring daily far outstrips the number of patients being placed on ART (World Health Organization, 2007), and to halt the expanding number eligible for treatment, a pressing priority for research is to determine ways of effectively involved in the different components of ART delivery and how should they be trained and supported? What are the costs of ART both to the health services and to the patients? integrating human immunodeficiency virus (HIV) prevention with ART delivery strategies. At present, most government-led ART programmes are based in district or tertiary-level hospitals. This limits the number who can be treated; as hospital services are overburdened, there is a severe shortage of clinical staff, especially physicians, and most hospitals are in urban settings and difficult to access by the majority of people who live in rural areas (Jaffar et al. 2005; Gilks et al. 2006). Home-based care may not be acceptable in many settings because of stigma issues, but it is being evaluated in at least one cluster randomized trial (Jaffar et al., unpublished data). Peripheral health facilities, run by nursing staff or clinical assistants, provide basic primary care in rural communities across Africa. Research is required to determine if ART could be initiated and maintained from such centres. Could the centres monitor patients for side effects from therapy? Could they make referrals to hospitals as and when appropriate? What kind of adherence support and behaviour counselling should the centres provide? How often should patients be followed up and by whom? What should be the minimum cadre of staff