Promoting presumptive diagnosis of severe HIV disease to increase uptake of antiretroviral therapy in HIV-infected infants
Bibliographic record
Abstract
7-11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK Despite successful scale up of anti-retroviral therapy (ART) in Malawi, the number of children initiating ART early in their life is low and mortality of HIV infected infants not accessing ART is high. Availability of PCR remains limited and despite presumptive diagnosis (PD) is recommended in the national guidelines, it is rarely used as a reason to start HIV-exposed infants on ART. Reasons may include factors at health worker and clinic level. Knowledge of these barriers is important to increase access to ART for this high risk group. A structured questionnaire with 11 closed questions was administered to one ART clinic staff member for each site (nurse or clinician) by team-members of the regular national ART supervision for Quarter 1/2009 in the central and southern region. Questions addressed specific reasons for low uptake of PD and tested providers' knowledge of the PD definition. Finally, the interviewer explained how to make a PD correctly using a job-aid. Over 2 weeks, respondents of 49 of 173 ART-sites completed the questionnaire. They were mainly clinical officers (22) and nurses (17) from a central hospital, 5 district hospitals, 3 rural hospitals, 13 health centers, and 27 other facilities such as mission hospitals, smaller clinics run by NGOs, armed forces or privately. Forty-one clinics provided HIV testing and counseling for pregnant women on-site and 35 clinics offered antiretrovirals for PMTCT. Most providers felt that children <18 month of age are under-represented in their ART-cohort, mentioned that generally few HIV exposed children are eligible for ART in their catchment area and that limited access to PCR are reasons for low uptake of PD (34/49 respondents each). Twenty-nine saw the presence of maternal HIV-antibodies as a barrier that makes the diagnosis difficult, and 20 noted that staff at the under 5 clinic or postnatal ward rarely identifies and refers HIV exposed infants to HIV-services. Twelve providers said they generally don't register children at that age. Of the 49 providers, 15 defined presumptive diagnosis correctly and 15 partly correct. Providers seem to be aware of the need to start more HIV-infected infants on ART and of structural barriers to access this service. Improved knowledge and sensitization of providers on how to diagnose severely ill HIV-exposed infants presumptively may increase access to ART for children in this age-group.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".