12 months follow up of psychiatric adolescents treated with a interprofessional intervention.

Aim : The aim is to study the first one year outcome of psychiatric adolescents treated with a multiprofessional intervention, in terms of psychopathology and global psychosocial functioning. The context is a Service for Adolescents, a daily center, which receives adolescents between 12 and 19 with psychopathological disorders of middle - severe seriousness. Multiprofessional team is formed by a child neuropsychiatrist, a psychologist and three educationals. Patients undergo a multimodal treatment, characterized by integrated educational and clinical actions. Sample : Among 100 adolescents who were referred to the Centre, 65 individuals had been clinically followed for 12 months. The sample is formed by 48 males (71,6%) and 19 females (28,4%) aged 12 to 19 years. 20 adolescents (31 %) attend primary school, 22 adolescents (34 %) secondary school, while 22 patients (35 %) interrupted educational career. Methodology: To verify the efficacy of treatments, it has run a retrospective study which has analysed those treated patients for whom one year follow up was available. The psychiatric disorders of the subjects were diagnosed according to ICD 10 (WHO 1994). The Global Assessment Functioning Scale (GAF) and Youth Self Report (YSR 11-18) were used to evaluate therapeutic efficacy of interventions 12 months after the beginning. Data about patients were collected in an anamnesis schedule, then transferred into a computerised database for computation, which is performed using SSPS version 10 and SAS\uae package, rel. 9.1.3. Results: One year follow up shows that the multiprofessional treatment has been efficacy. Actually, with regards to YSR scores, it is to be noticed a general improvement of symptoms and problems reported by adolescents 12 months. Moreover according to the operators\u2019 valuation throughout the GAF, one year later too, it is to be noticed a general improvement in the initial conditions, pointed out by the ascendant trends in the ratings

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated