Quality Care: The Package

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Quality Care The Package
International Center for AIDS Care and Treatment
Programs Annual Meeting, March 2006 Dar Es
Salaam, Tanzania

• Alan Berkman, MD
• Columbia-Clinton Foundation Dominican AIDS
  Initiative
• March 7, 2006

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Strategic Goal

• Optimize health and decrease morbidity and
  mortality from HIV and its related conditions

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Objectives

• Monitor CD4s and start treatment when first
  indicated
• Prevent Opportunistic infections and HIV-related
  conditions
• Promote adherence to care and prepare for
  adherence to treatment
• Improve nutritional status
• Stabilize the household

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CURRENT SITUATION

• Patients enter with advanced disease
• Colebunders et al., JID, 2005 Mean CD4 at
  initiation was 63 cells/microliter in Kampala
• Lawn Wood, JID, 2006 median CD4 for gt1000
  patients in Gugulethu was lt100

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Median CD4 at ART Initiation
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Low versus high CD4s

• morbidity and mortality
• Decreased duration of viral suppression
• Decreased restoration of immune function
• drug toxicity
• expense

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