Comparison of antiretroviral treatment abandonment rates in HIV-infected patients at a level III-1 referral hospital in Lima -Peru during pre pandemic and pandemic periods and exploration of associated factors

La adherencia al tratamiento antirretroviral (TAR) sigue siendo un pilar fundamental para lograr el descenso en la carga viral y aumento de los linfocitos T CD4+ en pacientes infectados por el virus de inmunodeficiencia humana (VIH) y por lo tanto evitar la progresión a síndrome de inmunodeficiencia adquirida (SIDA), las enfermedades oportunistas y la muerte. La pandemia ha traído consigo muchas dificultades, las cuales han repercutido en todos los ámbitos de la salud, sobre todo, en lo que respecta al manejo de enfermedades crónicas, como lo es el VIH/SIDA. Objetivos: Comparar las tasas de abandono del tratamiento antirretroviral durante la pre pandemia y la pandemia del COVID-19, así como explorar los factores asociados al abandono en pacientes infectados con el VIH de un hospital referencial de nivel III-1 en Lima, Perú. Métodos: Estudio observacional, analítico de tipo cohorte retrospectivo, con análisis de bases secundarias. Se siguió y seleccionó a todos los pacientes que acudieron a sus consultas control, según los criterios de inclusión y exclusión se incluyó un total de 1153 participantes. Se definió como pre pandemia al periodo desde el 1 de enero de 2019 hasta 15 de marzo de 2020, y como pandemia al periodo desde el 16 de marzo de 2020 hasta el 31 de diciembre de 2021. Se utilizó una base de datos preexistente obtenida de la atención clínica y se tomaron todas las medidas de protección de la privacidad al momento de la codificación. Con la información recolectada se elaboró una base de datos para análisis estadístico en STATA v.17 y se calculó la estadística de frecuencias y porcentajes para todas las variables categóricas y medidas de tendencia central para la edad, CD4+ y carga viral. Resultados: El porcentaje de abandono del tratamiento antirretroviral desde el 1 de enero de 2019 hasta el 31 de diciembre de 2021 en pacientes infectados por el VIH representó el 10.67% (n=123) del total de la población, y cuando este dato se disgregó en el porcentaje de abandono durante la pre pandemia y durante la pandemia, la tasa de abandono del tratamiento antirretroviral fue de 2.16% (n=14) y 21.58% (n=109) respectivamente p<0.00001 RR 9.99 [8.26 - 12.06]. Los factores asociados estadísticamente significativos fueron el consumo de alcohol/tabaco (p<0.001) RR de 9.187 IC95% [6.95 - 12.14] y el consumo de sustancias psicoactivas (p<0.001) RR de 10.95 IC95% [8.64 - 13.87]. Conclusiones: La tasa de abandono del tratamiento antirretroviral en pacientes infectados por el virus de la inmunodeficiencia humana durante la pandemia fue aproximadamente 10 veces mayor que la encontrada durante la pre pandemia. Los factores asociados al abandono fueron el consumo de alcohol/tabaco y el consumo de sustancias psicoactivas. Los niveles de CD4+ y carga viral fueron similares en ambos años.Adherence to antiretroviral treatment (ART) remains a fundamental pillar for achieving a decrease in viral load and an increase in CD4+ T lymphocytes in patients infected with the human immunodeficiency virus (HIV), thereby preventing progression to acquired immunodeficiency syndrome (AIDS), opportunistic diseases, and death. The pandemic has brought about many difficulties, which have had repercussions in all aspects of health, especially in the management of chronic diseases such as HIV/AIDS. Objectives: To compare rates of antiretroviral treatment abandonment during the pre-pandemic and COVID-19 pandemic periods, as well as to explore factors associated with abandonment in HIV-infected patients at a level III-1 referral hospital in Lima, Peru. Methods: An observational, analytical, retrospective cohort study with secondary data analysis was conducted. All patients attending follow-up appointments were followed and selected based on inclusion and exclusion criteria, resulting in 1153 participants. The pre-pandemic period was defined as January 1, 2019, to March 15, 2020, and the pandemic period as March 16, 2020, to December 31, 2021. A pre-existing database obtained from clinical care was used, and privacy protection measures were taken during coding. A database for statistical analysis in STATA v.17 was created with the collected information, and frequency and percentage statistics were calculated for all categorical variables, while measures of central tendency were calculated for age, CD4+, and viral load. Results: The percentage of antiretroviral treatment abandonment from January 1, 2019, to December 31, 2021, in HIV-infected patients represented 10.67% (n=123) of the total population. When this data was disaggregated into pre-pandemic and pandemic abandonment rates, the antiretroviral treatment abandonment rate was 2.16% (n=14) and 21.58% (n=109), respectively p<0.00001 RR 9.99 [8.26 - 12.06]. Statistically significant associated factors were alcohol/tobacco consumption (p<0.001) RR de 9.187 IC95% [6.95 - 12.14] and psychoactive substance use (p<0.001) RR de 10.95 IC95% [8.64 - 13.87]. Conclusions: The rate of antiretroviral treatment abandonment in patients infected with the human immunodeficiency virus during the pandemic was approximately 10 times higher than that found during the pre-pandemic period. The associated factors with abandonment were younger age, alcohol/tobacco consumption, and psychoactive substance use. CD4+ and viral load levels were similar in both years

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research