2 research outputs found
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Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study
Background: Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over
the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing
treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting.
Methods: We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in
two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional
hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment.
Results: Of 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive
patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were
significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003).
On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27),
unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI,
1.10–3.31) were significantly associated with a higher hazard of death.
Conclusions: We demonstrate that positive HIV status was a strong predictor of mortality among patients treated
for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and
antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational
research should document the changing profile of HIV-associated tuberculosis mortality
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Strengthening the role of Community Health Representatives in the Navajo Nation
Abstract Background Strengthening Community Health Worker systems has been recognized to improve access to chronic disease prevention and management efforts in low-resource communities. The Community Outreach and Patient Empowerment (COPE) Program is a Native non-profit organization with formal partnerships with both the Navajo Nation Community Health Representative (CHR) Program and the clinical facilities serving the Navajo Nation. COPE works to better integrate CHRs into the local health care system through training, strengthening care coordination, and a standardized culturally appropriate suite of health promotion materials for CHRs to deliver to high-risk individuals in their homes. Methods The objective of this mixed methods, cross sectional evaluation of a longitudinal cohort study was to explore how the COPE Program has effected CHR teams over the past 6 years. COPE staff surveyed CHRs in concurrent years (2014 and 2015) about their perceptions of and experience working with COPE, including potential effects COPE may have had on communication among patients, CHRs, and hospital-based providers. COPE staff also conducted focus groups with all eight Navajo Nation CHR teams. Results CHRs and other stakeholders who viewed our results agree that COPE has improved clinic-community linkages, primarily through strengthened collaborations between Public Health Nurses and CHRs, and access to the Electronic Health Records. CHRs perceived that COPE’s programmatic support has strengthened their validity and reputation with providers and clients, and has enhanced their ability to positively effect health outcomes among their clients. CHRs report an improved ability to deliver health coaching to their clients. Survey results show that 80.2% of CHRs feel strongly positive that COPE trainings are useful, while 44.6% of CHRs felt that communication and teamwork had improved because of COPE. Conclusions These findings suggest that CHRs have experienced positive benefits from COPE through training. COPE may provide a useful programmatic model on how best to support other Community Health Workers through strengthening clinic-community linkages, standardizing competencies and training support, and structuring home-based interventions for high-risk individuals