AIDS Clinical Care Research Articles

Assessing the pertinence and usefulness of HIV and AIDS indicators for evaluating clinical care quality: Perspectives of health care professionals

Following a systematic review of quality indicators employed in the evaluation of clinical care for individuals with HIV and AIDS, we performed “an exploratory study” that aims to assess the clinical significance and practical applicability of these indicators from the perspective of health care professionals (HCPs) specialising in HIV and AIDS care. Twenty-five HCPs filled out two questionnaires. From the initial list of 88 quality indicators, 50 were identified as the most relevant and useful in HIV and AIDS clinical care. Analysis was conducted on the individual indicators, and the outcomes were categorised into seven domains for clinical relevance and practical usefulness. Health care professionals deemed the functional organisational structure and the therapy domain to have the most pertinent and useful indicators among the seven different clinical domains, followed by the prevention domain.

Development of a Fundamental Set of Quality Indicators for Evaluating HIV and AIDS Clinical Care: A Systematic Review

Development of a Fundamental Set of Quality Indicators for Evaluating HIV and AIDS Clinical Care: A Systematic Review

Attitudes, practices, and priority of HIV screening and testing among clinical providers in Transylvania and Moldavia, Romania

Screening and linkage to care are core, foundational strategies for HIV transmission prevention and for identifying People Living with HIV (PLHIV). In Romania – with an atypical experience in the HIV/AIDS epidemic – providing care for HIV+ patients identified early is a priority, though screening and testing can pose a challenge in some areas.MethodsA survey of 125 clinical providers to explore important dimensions of HIV/ AIDS clinical care was conducted in Transylvania and Moldavia, where clinicians identified poor/ latent screening as a major problem in providing timely care and in preventing the spread of disease. We analyzed determinants of offering HIV screening/testing to patients using Pearson Chi-square analysis and logistic regression. Logistic regression generated Odds Ratios (OR) to reflect the magnitude of association between the relevant variables, with 95% confidence interval (95% CI) indicating statistical range.ResultsIn total, 40.8% of providers did not provide HIV screening/testing to at least one segment of the population. Hospital-based providers were significantly more likely to offer HIV screening/testing to all segments than were non-hospital-based providers (58.1% v. 35.5%, respectively; p < .05). Providers located within institutions with screening/testing policies were more likely to offer such services to their patients (p < .05). Overall, 94.4% of providers indicated interest in more training around HIV screening/testing.DiscussionReaching Romanian and global goals for reducing HIV require more timely screening and action based on positive status. Romanian clinicians are interested in expanding HIV screening/testing and are interested in participating in training that helps them feel more prepared to undertake this work.

HIV/AIDS Top Stories of 2014

2014 has been a year of transition for NEJM Journal Watch AIDS Clinical Care. Early in the year, after a decade at the helm, Dr. Paul Sax moved on to

Ten Years at

Looking Back It has been a privilege to be Editor at NEJM Journal Watch AIDS Clinical Care for the past decade, and such a rewarding experience that

HIV/AIDS Editors' Choice: Top Stories of 2013

This has been an exciting year for us, with organizational changes that are reflected in our new title: NEJM Journal Watch AIDS Clinical Care. We

Development of an electronic, integrated quality monitoring and needs assessment tool for palliative care.

e16556 Background: In order to facilitate uptake of continuous quality improvement in oncology and palliative care, practical data capture and reporting solutions are needed that allow real-time collection of structured data that simultaneously contributes to quality measurement and aids clinical care. We aimed to build and test a point-of-care system for continuous quality monitoring in community palliative care. Methods: Within a four-organization, academic/community quality consortium, we first conducted a focus group to inventory characteristics of an effective system. A systematic review and prioritization of quality measures for supportive oncology and palliative care followed. These results informed development of a set of data elements and electronic platform. A usability study with think-aloud protocols was then conducted with twenty providers using two mock cases across paper, laptop, and tablet computer platforms. Results: Identified priorities for a proposed system were: 1. Use of information technology (IT); 2. Point-of-care use with patient-report and provider-entry; and 3. Immediate, provider-level reporting on quality conformance. In the systematic review, 282 quality measures (152 prioritized for clinical utility and feasibility) for supportive oncology and palliative care were identified; these measures informed the development of a 92 item dataset of validated clinical tools within National Quality Forum quality domains. Data elements were harmonized with the National Cancer Institute’s Cancer Bioinformatics Grid (CaBIG) and other metadata sets. To foster electronic, point-of-care data capture, the Quality Data Collection Tool (QDACT) was then developed. The QDACT informs 82% (125) of high-priority quality measures; a color-code reminder system provides immediate conformance feedback. The usability study demonstrated high satisfaction, less than 15 minutes for completion, and a low error rate. Conclusions: Electronic systems that can integrate point-of-care quality monitoring and clinical assessments are buildable and usable in palliative care. Feasibility testing within the context of routine outpatient and inpatient palliative care practice is ongoing.

Ethnographic experiences of HIV-positive nurses in managing stigma at a clinic in rural Uganda

This paper explores the workplace experiences of HIV-positive nurses and their attempts to manage HIV/AIDS stigma. An HIV diagnosis can have a major impact on an individual's psychological and emotional wellbeing. Moreover, caring for those suffering from chronic HIV-related illnesses comes with additional stress, which makes providing care more complex. Stigma-reduction and assisting with psychosocial support and wellbeing is an integral part of ensuring that care providers who are HIV-positive have good outcomes both for themselves and their patients. An ethnographic study with HIV-positive nurses was conducted from August 2005 to December 2007 at a Health Centre IV HIV clinic in rural Luweero district, Uganda. Data were gathered through clinical participant observation, informal conversations, recorded life histories, open-ended in-depth interviews and topical focus group discussions. Nurses are in a position to help people through negative life events, yet they may personally experience the same types of negative life events. In the absence of a system to provide support for HIV and AIDS clinical care providers, a group of HIV-positive nurses initiated a support process by creating safe spaces for interacting and seeking psychosocial support among themselves in a relatively secretive way. This process provided the nurses with a solid foundation for developing interventions to assist them through difficult times.

Top HIV/AIDS Stories of 2009

Dear Readers, Next week, the editors of Journal Watch AIDS Clinical Care will provide our annual review of what we considered to be the most important stories in HIV medicine this year. First, though, we offer two “Top 10” …

Top HIV/AIDS Stories of 2007

Dear Readers,Every winter, when the editors of AIDS Clinical Care look back over 12 months of HIV clinical care and research to choose our top stories,

Michel Kazatchkine: The Global Fund's new Executive Director

In 1983 Michel Kazatchkine was a clinical immunologist at Hopital Broussais in Paris France when he was called to see a French couple with unexplained fever severe immune deficiency who had been airlifted home from Africa. This man woman were first of many AIDS patients that Kazatchkine would take care of in coming decades. There were no effective antiretroviral treatments available couple lived only a few months on ward before Those were difficult years with patients dying every day on wards Kazatchkine recalls. Much of his time he says was spent providing end-of-life care consoling patients and holding their hands when they were dying. This year after more than two decades of working in AIDS clinical care research international programmes Kazatchkine takes over helm of second largest funder of AIDS care: Global Fund to Fight AIDS Tuberculosis & Malaria. Anthony Fauci Director of US National Institute of Allergy andInfectious Disease who says he has worked up close personal with Kazatchkine since early days of epidemic calls him the perfect kind of person for position. a scientist who understands science; a clinician who understands clinical care; an expert in AIDS who understands epidemic Fauci says. Hes also a fine people person: kind of person who can build consensus but also kind of person who can take lead. (excerpt)

Top HIV/AIDS Stories of 2006

Each year, the editors of AIDS Clinical Care choose the year’s top stories. In making our choices, we try to strike a balance between relevance to HIV

Letter from Haiti.

Never have the global inequities in the AIDS epidemic been more apparent than in the last few years. As AIDS death rates drop in the United States, they soar over the rest of the globe. As the number of infants born with HIV infection in this country plummets, thanks to widespread use of AZT in pregnancy, the corresponding numbers for developing nations grow more dismal by the day, because AZT prophylaxis is costly. To call attention to the wrenching situations physicians face in trying to stem the tide of the epidemic in these parts of the world, we are with this issue inaugurating a new feature for AIDS Clinical Care : periodic letters from overseas AIDS clinicians. This month, Dr. Paul Farmer writes to us from Haiti. Four months of the year Dr. Farmer, who is Associate Professor of Social Medicine at Harvard Medical School, is an infectious disease specialist at the Brigham and Women's Hospital in Boston. The rest of the year he spends mainly in rural Haiti at the Clinique Bon Sauveur, which he and his coworkers founded in 1985. Dr. Farmer, a recipient of the MacArthur fellowship, and his colleagues also founded Partners in Health, a nonprofit organization to support the Clinique Bon Sauveur and other medical projects in Haiti and South America (see address at end of article). -- Deborah Cotton, MD, MPH Founded in 1985, the Clinique Bon Sauveur serves the rural poor of Haiti's Central Plateau. Within a year of opening, we saw our first case of AIDS in a young man who presented with disseminated tuberculosis. In the intervening decade, we've cared for hundreds of patients, a majority of them women, and learned a great deal. We soon found, for example, that tuberculosis would be our leading opportunistic infection. We eventually discovered why …

Robert Bovenschulte to head ACS Publications

Robert D. Bovenschulte has been appointed director of the Publications Division of the American Chemical Society, effective Jan. 2, 1997. He succeeds Robert H. Marks, who is retiring after more than eight years as director. Bovenschulte will report to ACS Executive Director John K Crum. Bovenschulte, 53, has extensive experience in professional and scholarly publishing. He is currently vice president for publishing at the Massachusetts Medical Society and the New England Journal of Medicine ( NEJM ). He directs a $60 million publishing operation that includes, besides NEJM, Journal Watch, Morbidity & Mortality Weekly Report, AIDS Clinical Care, Clinical Care for Prostatic Diseases, and Health News . He oversees a staff of 185 people in marketing, sales, product management, editorial development (excluding NEJM ), production, manufacturing, distribution, customer service, and computer information systems. Under his direction, revenues have grown from $40 million to $60 million in six years. He has also sig...

Commentary: the need for specialization in AIDS clinical care.

Commentary: the need for specialization in AIDS clinical care.