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Artikel ; Online: Antibiotic susceptibility patterns of pathogens isolated from hospitalized patients with advanced HIV disease (AHD) in Bihar, India.

Kumar, Vikash / Murali, Shreyas / Goldberg, Jacob / Alonso, Beatriz / Moretó-Planas, Laura / Reid, Anthony / Harshana, Amit / Burza, Sakib / Mahajan, Raman

JAC-antimicrobial resistance

2024 Band 6, Heft 1, Seite(n) dlad151

Abstract: Objectives: To describe the prevalence of common bacterial pathogens and antibiotic susceptibility patterns amongst advanced HIV disease (AHD) patients admitted between May 2019 and March 2021 to a Médecins Sans Frontières (MSF)-supported AHD inpatient ... ...

Abstract	Objectives: To describe the prevalence of common bacterial pathogens and antibiotic susceptibility patterns amongst advanced HIV disease (AHD) patients admitted between May 2019 and March 2021 to a Médecins Sans Frontières (MSF)-supported AHD inpatient unit in Bihar, India. Methods: A retrospective analysis of routinely collected demographic, clinical and microbiological data. Antibacterial susceptibility testing was done by an accredited referral laboratory using the modified Kirby-Bauer disc diffusion method. Results: A total of 238 isolates from 577 patients were identified through culture testing. Patient median (IQR) age was 38 (31-45) years, and 75% were male. Predominant sample types included blood (600; 38%), urine (266; 17%) and sputum (178; 11%). Of the isolated bacteria, Conclusions: In Bihar, inpatients with AHD displayed a concerning array of antibiotic-resistant infections. This study provides a starting point from which further work on antimicrobial resistance in this vulnerable cohort of patients can be conducted.
Sprache	Englisch
Erscheinungsdatum	2024-01-02
Erscheinungsland	England
Dokumenttyp	Journal Article
ISSN	2632-1823
ISSN (online)	2632-1823
DOI	10.1093/jacamr/dlad151
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Behavioural interventions to address rational use of antibiotics in outpatient settings of low-income and lower-middle-income countries.

Nair, Mohit M / Mahajan, Raman / Burza, Sakib / Zeegers, Maurice P

Tropical medicine & international health : TM & IH

2021 Band 26, Heft 5, Seite(n) 504–517

Abstract: Objectives: To explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low-income and lower-middle-income countries, an underrepresented area in the literature.: ... ...

Abstract	Objectives: To explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low-income and lower-middle-income countries, an underrepresented area in the literature. Methods: The systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low-income and lower-middle-income countries. Behavioural interventions were classified as persuasive, enabling, restrictive, structural or bundle (mix of different interventions). In total, 3,514 abstracts were screened and 42 studies were selected for full-text review, with 13 studies included in the final narrative synthesis. Results: Of the 13 included studies, five were conducted in Vietnam, two in Sudan, two in Tanzania, two in India and two in Kenya. All studies were conducted in the outpatient or ambulatory setting: eight took place in primary health centres, two in private clinics and three in pharmacies. Our review found that enabling or educational interventions alone may not be sufficient to overcome the ingrained incentives to link revenue generation to sales of antibiotics, and hence, their inappropriate prescription or misuse. Bundle interventions appear to be very effective at changing prescription behaviour among healthcare providers, including drug sellers and pharmacists. Conclusions: Multi-faceted bundle interventions that combine regulation enforcement with face-to-face education and peer influence may be more effective than educational interventions alone at curbing inappropriate antibiotic use.
Mesh-Begriff(e)	Ambulatory Care Facilities ; Anti-Bacterial Agents/therapeutic use ; Developing Countries ; Guideline Adherence/statistics & numerical data ; Humans ; Inappropriate Prescribing/prevention & control ; India ; Kenya ; Outpatients ; Practice Patterns, Physicians'/statistics & numerical data ; Sudan ; Tanzania ; Vietnam
Chemische Substanzen	Anti-Bacterial Agents
Sprache	Englisch
Erscheinungsdatum	2021-01-28
Erscheinungsland	England
Dokumenttyp	Journal Article ; Systematic Review
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.13550
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Concomitant bedaquiline and delamanid therapy in patients with drug-resistant extra-pulmonary tuberculosis in Mumbai, India.

Mongia, Himani / Mamnoon, Fatima / Silsarma, Arunima / Mahajan, Raman / Dalal, Alpa / Galindo, Miriam Arago / Iyer, Aparna / Singh, Pramila / Mansoor, Homa / Das, Mrinalini / Morales, Mabel / Spencer, Hannah / Isaakidis, Petros

Journal of clinical tuberculosis and other mycobacterial diseases

2024 Band 35, Seite(n) 100433

Abstract: Background: World Health Organization suggests concurrent bedaquiline-delamanid (BDQ-DLM) as part of individualised regimens for eligible patients with pulmonary drug-resistant tuberculosis (DR-TB); however, data for patients with drug-resistant ... ...

Abstract	Background: World Health Organization suggests concurrent bedaquiline-delamanid (BDQ-DLM) as part of individualised regimens for eligible patients with pulmonary drug-resistant tuberculosis (DR-TB); however, data for patients with drug-resistant extrapulmonary tuberculosis (EPTB) is extremely limited. This study documents the treatment outcomes and adverse events associated with concurrent BDQ-DLM-based regimens in patients with drug-resistant EPTB at a Médecins Sans Frontières clinic in Mumbai, India. Methods: Retrospective cohort study based on routinely collected programmatic data. Individualised regimens were based on drug-susceptibility testing and previous drug exposure. Drug-resistant EPTB patients initiated on regimens containing concurrent BDQ and DLM from April 2016 to October 2019 were included. Patients who completed treatment were followed up at 12 months. Results: Of 17 patients, median age was 23 years (IQR = 21-30 years) and 12/17 (71 %) were female. Pre-extensively drug-resistant tuberculosis and extensively drug-resistant TB was reported in 13/17 (76.4 %) and 2/17 (11.7 %) patients respectively. Microbiological reports were unavailable for two patients with central nervous system TB. Lymph node TB was the commonest form of EPTB in 9/17 (53 %) of patients. Median duration of treatment was 18.9 months. At least one grade three or four severe adverse event (SAE) was reported by 13/17 (76.4 %) patients. Thirteen (76.4 %) patients had favourable outcomes. None of the patients relapsed or died in the one-year period of post-treatment follow-up. Conclusion: Concurrent BDQ-DLM-based regimens in drug-resistant EPTB were effective and associated with manageable adverse events.
Sprache	Englisch
Erscheinungsdatum	2024-04-01
Erscheinungsland	England
Dokumenttyp	Journal Article
ISSN	2405-5794
ISSN (online)	2405-5794
DOI	10.1016/j.jctube.2024.100433
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Prevalence and determinants of asymptomatic Leishmania infection in HIV-infected individuals living within visceral leishmaniasis endemic areas of Bihar, India.

Mahajan, Raman / Owen, Sophie I / Kumar, Shiril / Pandey, Krishna / Kazmi, Shahwar / Kumar, Vikash / Adams, Emily R / Harshana, Amit / Burza, Sakib

PLoS neglected tropical diseases

2022 Band 16, Heft 8, Seite(n) e0010718

Abstract: People living with HIV (PLHIV) have an increased risk of developing visceral leishmaniasis (VL) and poor outcomes compared to HIV negative individuals. Here, we aim to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) ... ...

Abstract	People living with HIV (PLHIV) have an increased risk of developing visceral leishmaniasis (VL) and poor outcomes compared to HIV negative individuals. Here, we aim to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) in a cohort of PLHIV in Bihar, India. We hoped to evaluate optimal diagnostic algorithms to detect ALI in PLHIV. We conducted a cross-sectional survey of PLHIV ≥18 years of age with no history or current diagnosis of VL or post kala-azar dermal leishmaniasis (PKDL) at anti-retroviral therapy centres within VL endemic districts of Bihar. ALI was defined as a positive rK39 enzyme-linked immunosorbent assay (ELISA), rK39 rapid diagnostic test (RDT) and/or quantitative polymerase chain reaction (qPCR). Additionally, the urinary Leishmania antigen ELISA was evaluated. Determinants for ALI were established using logistic regression and agreement between diagnostic tests calculated using Cohen's Kappa. A total of 1,296 PLHIV enrolled in HIV care, 694 (53.6%) of whom were female and a median age of 39 years (interquartile range 33-46), were included in the analysis. Baseline prevalence of ALI was 7.4% (n = 96). All 96 individuals were positive by rK39 ELISA, while 0.5% (n = 6) and 0.4% (n = 5) were positive by qPCR and rK39 RDT, respectively. Negligible or weak agreement was seen between assays. Independent risk factors for ALI were CD4 counts <100 (OR 3.1; 95% CI 1.2-7.6) and CD4 counts 100-199 (OR = 2.1;95% CI:1.1-4.0) compared to CD4 counts ≥300, and a household size ≥5 (OR = 1.9;95% CI:1.1-3.1). A total of 2.2% (n = 28) participants were positive by Leishmania antigen ELISA, detecting 20 additional participants to the asymptomatic cohort. Prevalence of ALI in PLHIV in VL endemic villages in Bihar was relatively high. Using the Leishmania antigen ELISA, prevalence increased to 9.0%. Patients with low CD4 counts and larger household size were found to have significantly higher risk of ALI. Trial Registration: Clinical Trial Registration CTRI/2017/03/008120.
Mesh-Begriff(e)	Adult ; Asymptomatic Infections/epidemiology ; Cross-Sectional Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; HIV Infections/complications ; HIV Infections/epidemiology ; Humans ; India/epidemiology ; Leishmania ; Leishmania donovani ; Leishmaniasis ; Leishmaniasis, Visceral/complications ; Leishmaniasis, Visceral/diagnosis ; Leishmaniasis, Visceral/epidemiology ; Male ; Middle Aged ; Prevalence
Sprache	Englisch
Erscheinungsdatum	2022-08-30
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2735
ISSN (online)	1935-2735
ISSN	1935-2735
DOI	10.1371/journal.pntd.0010718
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Host Biomarkers Reflect Prognosis in Patients Presenting With Moderate Coronavirus Disease 2019: A Prospective Cohort Study.

Chandna, Arjun / Mahajan, Raman / Gautam, Priyanka / Mwandigha, Lazaro / Kumar, Pragya / Varghese, George M / Koshiaris, Constantinos / Lubell, Yoel / Burza, Sakib

Open forum infectious diseases

2022 Band 9, Heft 10, Seite(n) ofac526

Abstract: Efficient resource allocation is essential for effective pandemic response. We measured host biomarkers in 420 patients presenting with moderate coronavirus disease 2019 and found that different biomarkers predict distinct clinical outcomes. Interleukin ( ...

Abstract	Efficient resource allocation is essential for effective pandemic response. We measured host biomarkers in 420 patients presenting with moderate coronavirus disease 2019 and found that different biomarkers predict distinct clinical outcomes. Interleukin (IL)-1ra, IL-6, IL-10, and IL-8 exhibit dose-response relationships with subsequent disease progression and could potentially be useful for multiple use-cases.
Sprache	Englisch
Erscheinungsdatum	2022-10-06
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac526
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Point-of-care prognostication in moderate Covid-19: Analytical validation and prognostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test.

Chandna, Arjun / Mahajan, Raman / Gautam, Priyanka / Mwandigha, Lazaro / Dittrich, Sabine / Kumar, Vikash / Osborn, Jennifer / Kumar, Pragya / Koshiaris, Constantinos / Varghese, George M / Lubell, Yoel / Burza, Sakib

PLOS global public health

2023 Band 3, Heft 8, Seite(n) e0001538

Abstract: The soluble urokinase plasminogen activator receptor (suPAR) has been proposed as a biomarker for risk stratification of patients presenting with acute infections. However, most studies evaluating suPAR have used platform-based assays, the accuracy of ... ...

Abstract	The soluble urokinase plasminogen activator receptor (suPAR) has been proposed as a biomarker for risk stratification of patients presenting with acute infections. However, most studies evaluating suPAR have used platform-based assays, the accuracy of which may differ from point-of-care tests capable of informing timely triage in settings without established laboratory capacity. Using samples and data collected during a prospective cohort study of 425 patients presenting with moderate Covid-19 to two hospitals in India, we evaluated the analytical performance and prognostic accuracy of a commercially-available rapid diagnostic test (RDT) for suPAR, using an enzyme-linked immunosorbent assay (ELISA) as the reference standard. Our hypothesis was that the suPAR RDT might be useful for triage of patients presenting with moderate Covid-19 irrespective of its analytical performance when compared with the reference test. Although agreement between the two tests was limited (bias = -2.46 ng/mL [95% CI = -2.65 to -2.27 ng/mL]), prognostic accuracy to predict supplemental oxygen requirement was comparable, whether suPAR was used alone (area under the receiver operating characteristic curve [AUC] of RDT = 0.73 [95% CI = 0.68 to 0.79] vs. AUC of ELISA = 0.70 [95% CI = 0.63 to 0.76]; p = 0.12) or as part of a published multivariable prediction model (AUC of RDT-based model = 0.74 [95% CI = 0.66 to 0.83] vs. AUC of ELISA-based model = 0.72 [95% CI = 0.64 to 0.81]; p = 0.78). Lack of agreement between the RDT and ELISA in our cohort warrants further investigation and highlights the importance of assessing candidate point-of-care tests to ensure management algorithms reflect the assay that will ultimately be used to inform patient care. Availability of a quantitative point-of-care test for suPAR opens the door to suPAR-guided risk stratification of patients with Covid-19 and other acute infections in settings with limited laboratory capacity.
Sprache	Englisch
Erscheinungsdatum	2023-08-21
Erscheinungsland	United States
Dokumenttyp	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0001538
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Xpert-Ultra Assay in Stool and Urine Samples to Improve Tuberculosis Diagnosis in Children: The Médecins Sans Frontières Experience in Guinea-Bissau and South Sudan.

Open forum infectious diseases

2024 Band 11, Heft 5, Seite(n) ofae221

Abstract: Background: More than half of childhood tuberculosis cases remain undiagnosed yearly. The World Health Organization recommends the Xpert-Ultra assay as a first pediatric diagnosis test, but microbiological confirmation remains low. We aimed to determine ...

Abstract	Background: More than half of childhood tuberculosis cases remain undiagnosed yearly. The World Health Organization recommends the Xpert-Ultra assay as a first pediatric diagnosis test, but microbiological confirmation remains low. We aimed to determine the diagnostic performance of Xpert-Ultra with stool and urine samples in presumptive pediatric tuberculosis cases in 2 high-tuberculosis-burden settings. Methods: This Médecins Sans Frontières cross-sectional multicentric study took place at Simão Mendes Hospital, Guinea-Bissau (July 2019 to April 2020) and in Malakal Hospital, South Sudan (April 2021 to June 2023). Children aged 6 months to 15 years with presumptive tuberculosis underwent clinical and laboratory assessment, with 1 respiratory and/or extrapulmonary sample (reference standard [RS]), 1 stool, and 1 urine specimen analyzed with Xpert-Ultra. Results: A total of 563 children were enrolled in the study, 133 from Bissau and 400 from Malakal; 30 were excluded. Confirmation of tuberculosis was achieved in 75 (14.1%), while 248 (46.5%) had unconfirmed tuberculosis. Of 553 with an RS specimen, the overall diagnostic yield was 12.4% (66 of 533). A total of 493 stool and 524 urine samples were used to evaluate the performance of Xpert-Ultra with these samples. Compared with the RS, the sensitivity and specificity of Xpert-Ultra were 62.5% (95% confidence interval, 49.4%-74%) and 98.3% (96.7%-99.2%), respectively, with stool samples, and 13.9% (7.5%-24.3%) and 99.4% (98.1%-99.8%) with urine samples. Nine patients were positive with stool and/or urine samples but negative with the RS. Conclusions: Xpert-Ultra in stool samples showed moderate to high sensitivity and high specificity compared with the RS and an added diagnostic yield when RS results were negative. Xpert-Ultra in stool samples was useful in extrapulmonary cases. Xpert-Ultra in urine samples showed low test performance. Clinical trials registration: NCT06239337.
Sprache	Englisch
Erscheinungsdatum	2024-05-02
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofae221
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India.

Acharya, Shrikala / Allam, Ramesh Reddy / Karanjkar, Vijay Kumar / Rathod, Dhirubhai / Mahajan, Raman / Deshpande, Prashant / Palkar, Amol / Todmal, Shashikant / Koli, Sagar / Dhande, Sachin / Dale, Jayesh / Yeldandi, Vijay V / Harshana, Amit / Agarwal, Reshu / Upadhyaya, Sunita / Nyendak, Melissa

BMJ open

2023 Band 13, Heft 6, Seite(n) e070500

Abstract: Objectives: To describe the implementation of screening for cryptococcal antigenaemia by point-of-care (POC) serum cryptococcal antigen (CrAg) lateral flow assay, measure the prevalence and factors associated with serum cryptococcal antigenaemia in the ... ...

Abstract	Objectives: To describe the implementation of screening for cryptococcal antigenaemia by point-of-care (POC) serum cryptococcal antigen (CrAg) lateral flow assay, measure the prevalence and factors associated with serum cryptococcal antigenaemia in the routine programmatic setting. Design: Cross-sectional study. Setting: Seventeen publicly funded antiretroviral therapy (ART) centres in Mumbai, India. Participants: Serum CrAg screening was offered to all adolescents (>10 years of age) and adults with advanced HIV disease (AHD) (CD4 <200 cells/mm Primary and secondary outcome measures: The primary outcome was to describe the implementation of serum CrAg screening and secondary outcome was to measure the prevalence of serum cryptococcal antigenaemia and its risk factors. Results: A total of 2715 patients with AHD were tested for serum CrAg by POC assay. Of these, 25 (0.9%) had a CrAg positive result. Among CrAg-positive patients, only one had symptoms. Serum CrAg positivity was 3.6% (6/169) and 1.6% (6/520) among those presenting with CD4 <100 cells/mm Conclusions: Implementation of a POC CrAg assay was possible with existing ART centre staff. Initiation of pre-emptive therapy and management of cryptococcal antigenaemia are operationally feasible at ART centres. The Indian National AIDS Control Programme may consider reflexive CrAg screening of all AHD patients with CD4 <100 cells/mm
Mesh-Begriff(e)	Adult ; Adolescent ; Humans ; Prevalence ; Cross-Sectional Studies ; HIV Infections/complications ; HIV Infections/epidemiology ; HIV Infections/drug therapy ; Cryptococcus ; Point-of-Care Testing ; Antigens, Fungal/analysis ; India/epidemiology ; CD4 Lymphocyte Count
Chemische Substanzen	Antigens, Fungal
Sprache	Englisch
Erscheinungsdatum	2023-06-22
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-070500
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Diagnostic accuracy of commercially available immunochromatographic rapid tests for diagnosis of dengue in India.

Mahajan, Raman / Nair, Mohit / Saldanha, Ana-Maria / Harshana, Amit / Pereira, Alan De Lima / Basu, Nandita / Goswami, Rama Prasad / Bhattacharya, Nemai / Bandyopadhay, Bhaswati / SenGupta, Manideepa / Day, Moutusi / Flevaud, Laurence / Boelaert, Marleen / Burza, Sakib

Journal of vector borne diseases

2022 Band 58, Heft 2, Seite(n) 159–164

Abstract: Background & objectives: There is limited evidence regarding the accuracy of dengue rapid diagnostic kits despite their extensive use in India. We evaluated the performance of four immunochromatographic Rapid Diagnostic Test (RDTs) kits: Multisure ... ...

Abstract	Background & objectives: There is limited evidence regarding the accuracy of dengue rapid diagnostic kits despite their extensive use in India. We evaluated the performance of four immunochromatographic Rapid Diagnostic Test (RDTs) kits: Multisure dengue Ab/Ag rapid test (MP biomedicals; MP), Dengucheck combo (Zephyr Biomedicals; ZB), SD bioline dengue duo (Alere; SD) and Dengue day 1 test (J Mitra; JM). Methods: This is a laboratory-based diagnostic evaluation study. Rapid tests results were compared to reference non-structural (NS1) antigen or immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) results of 241 dengue-positive samples and 247 dengue-negative samples. Sensitivity and specificity of NS1 and IgM components of each RDT were calculated separately and in combination (either NS1 or IgM positive) against reference standard ELISA. Results: A total of 238, 226, 208, and 146 reference NS1 ELISA samples were tested with MP, ZB, SD, and JM tests, respectively. In comparison to the NS1 ELISA reference tests, the NS1 component of MP, ZB, SD, and JM RDTs demonstrated a sensitivity of 71.8%, 85.1%, 77.2% and 80.9% respectively and specificity of 90.1%, 92.8%, 96.1 %, and 93.6%, respectively. In comparison to the IgM ELISA reference test, the IgM component of RDTs showed a sensitivity of 40.0%, 50.3%, 47.3% and 20.0% respectively and specificity of 92.4%, 88.6%, 96.5%, and 92.2% respectively. Combining NS1 antigen and IgM antibody results led to sensitivities of 87.5%, 82.9%, 93.8% and 91.7% respectively, and specificities of 75.3%, 73.9%, 76.5%, and 80.0% respectively. Interpretation & conclusion: Though specificities were acceptable, the sensitivities of each test were markedly lower than manufacturers' claims. These results also support the added value of combined antigen-and antibody-based RDTs for the diagnosis of acute dengue.
Mesh-Begriff(e)	Antibodies, Viral ; Dengue/diagnosis ; Dengue Virus ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin M ; Sensitivity and Specificity ; Viral Nonstructural Proteins
Chemische Substanzen	Antibodies, Viral ; Immunoglobulin M ; Viral Nonstructural Proteins
Sprache	Englisch
Erscheinungsdatum	2022-01-15
Erscheinungsland	India
Dokumenttyp	Journal Article
ZDB-ID	2161218-3
ISSN	0972-9062
ISSN	0972-9062
DOI	10.4103/0972-9062.321747
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Lived experiences of palliative care among people living with HIV/AIDS: a qualitative study from Bihar, India.

Nair, Mohit / Kumar, Pragya / Mahajan, Raman / Harshana, Amit / Richardson, Kathryn / Moreto-Planas, Laura / Burza, Sakib

BMJ open

2020 Band 10, Heft 10, Seite(n) e036179

Abstract: Objectives: This study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand the broader palliative care context in ...

Abstract	Objectives: This study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand the broader palliative care context in Bihar. Design: This was an exploratory, qualitative study which used thematic analysis of semistructured, in-depth interviews as well as a focus group discussion. Setting: All interviews took place in a secondary care hospital in Patna, Bihar which provides holistic care to critically unwell PLHA. Participants: We purposively selected 29 participants: 10 critically unwell PLHA, 5 caregivers of hospitalised patients, 7 relatives of deceased patients who were treated in the secondary care hospital and 7 key informants from community-based organisations. Results: Critically ill PLHA emphasised the need for psychosocial counselling and opportunities for social interaction in the ward, as well as a preference for components of home-based palliative care, even though they were unfamiliar with actual terms such as 'palliative care' and 'end-of-life care'. Critically unwell PLHA generally expressed preference for separate, private inpatient areas for end-of-life care. Relatives of deceased patients stated that witnessing patients' deaths caused trauma for other PLHA. Caregivers and relatives of deceased patients felt there was inadequate time and space for grieving in the hospital. While both critically ill PLHA and relatives wished that poor prognosis be transparently disclosed to family members, many felt it should not be disclosed to the dying patients themselves. Conclusions: Despite expected high inpatient fatality rates, PLHA in Bihar lack access to palliative care services. PLHA receiving end-of-life care in hospitals should have a separate dedicated area, with adequate psychosocial counselling and activities to prevent social isolation. Healthcare providers should make concerted efforts to inquire, understand and adapt their messaging on prognosis and end-of-life care based on patients' preferences.
Mesh-Begriff(e)	Family ; HIV Infections/therapy ; Humans ; India ; Palliative Care ; Qualitative Research
Sprache	Englisch
Erscheinungsdatum	2020-10-05
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2019-036179
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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