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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
CMV retinitis screening and treatment in a resource-poor setting: Three-year experience from a primary care HIV/AIDS programme in Myanmar
Journal of the International AIDS Society, Volume 14, No. 1, Article 41, Year 2011
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Description
Background: Cytomegalovirus retinitis is a neglected disease in resource-poor settings, in part because of the perceived complexity of care and because ophthalmologists are rarely accessible. In this paper, we describe a pilot programme of CMV retinitis management by non-ophthalmologists. The programme consists of systematic screening of all high-risk patients (CD4 <100 cells/mm3) by AIDS clinicians using indirect ophthalmoscopy, and treatment of all patients with active retinitis by intravitreal injection of ganciclovir. Prior to this programme, CMV retinitis was not routinely examined for, or treated, in Myanmar. Methods. This is a retrospective descriptive study. Between November 2006 and July 2009, 17 primary care AIDS clinicians were trained in indirect ophthalmoscopy and diagnosis of CMV retinitis; eight were also trained in intravitreal injection. Evaluation of training by a variety of methods documented high clinical competence. Systematic screening of all high-risk patients (CD4 <100 cells/mm3) was carried out at five separate AIDS clinics throughout Myanmar. Results: A total of 891 new patients (1782 eyes) were screened in the primary area (Yangon); the majority of patients were male (64.3%), median age was 32 years, and median CD4 cell count was 38 cells/mm3. CMV retinitis was diagnosed in 24% (211/891) of these patients. Bilateral disease was present in 36% of patients. Patients with active retinitis were treated with weekly intravitreal injection of ganciclovir, with patients typically receiving five to seven injections per eye. A total of 1296 injections were administered. Conclusions: A strategy of management of CMV retinitis at the primary care level is feasible in resource-poor settings. With appropriate training and support, CMV retinitis can be diagnosed and treated by AIDS clinicians (non-ophthalmologists), just like other major opportunistic infections. © 2011 Tun et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Tun, Nini
Unknown Affiliation
London, Nikolas
United States, Philadelphia
Wills Eye Hospital
Kyaw, Moe
Switzerland, Geneva
Medecins Sans Frontieres
Smithuis, Frank M.
Unknown Affiliation
Ford, Nathan P.
Switzerland, Geneva
Medecins Sans Frontieres
South Africa, Cape Town
University of Cape Town
Margolis, Todd P.
United States, San Francisco
University of California, San Francisco
Drew, William Lawrence
United States, San Francisco
University of California, San Francisco
Lewallen, Susan
Tanzania
Kilimanjaro Centre for Community Ophthalmology
Heiden, David
United States, San Francisco
California Pacific Medical Center
United States, Berkeley
Seva Foundation
Statistics
Citations: 9
Authors: 9
Affiliations: 7
Identifiers
Doi:
10.1186/1758-2652-14-41
e-ISSN:
17582652
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Participants Gender
Male