CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar

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dc.contributor.authorTun, NiNien_ZA
dc.contributor.authorLondon, Nikolasen_ZA
dc.contributor.authorKyaw, Moeen_ZA
dc.contributor.authorSmithuis, Franken_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorMargolis, Todden_ZA
dc.contributor.authorDrew, W Lawrenceen_ZA
dc.contributor.authorLewallen, Susanen_ZA
dc.contributor.authorHeiden, Daviden_ZA
dc.date.accessioned2015-11-18T03:58:51Z
dc.date.available2015-11-18T03:58:51Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: 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.en_ZA
dc.identifier.apacitationTun, N., London, N., Kyaw, M., Smithuis, F., Ford, N., Margolis, T., ... Heiden, D. (2011). CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar. <i>Journal of the International AIDS Society</i>, http://hdl.handle.net/11427/15086en_ZA
dc.identifier.chicagocitationTun, NiNi, Nikolas London, Moe Kyaw, Frank Smithuis, Nathan Ford, Todd Margolis, W Lawrence Drew, Susan Lewallen, and David Heiden "CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar." <i>Journal of the International AIDS Society</i> (2011) http://hdl.handle.net/11427/15086en_ZA
dc.identifier.citationTun, N., London, N., Kyaw, M. K., Smithuis, F., Ford, N., Margolis, T., ... & Heiden, D. (2011). 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, 14(1), 41.en_ZA
dc.identifier.ris TY - Journal Article AU - Tun, NiNi AU - London, Nikolas AU - Kyaw, Moe AU - Smithuis, Frank AU - Ford, Nathan AU - Margolis, Todd AU - Drew, W Lawrence AU - Lewallen, Susan AU - Heiden, David AB - 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. DA - 2011 DB - OpenUCT DO - 10.1186/1758-2652-14-41 DP - University of Cape Town J1 - Journal of the International AIDS Society LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar TI - CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar UR - http://hdl.handle.net/11427/15086 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15086
dc.identifier.urihttp://dx.doi.org/10.1186/1758-2652-14-41
dc.identifier.vancouvercitationTun N, London N, Kyaw M, Smithuis F, Ford N, Margolis T, et al. 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. 2011; http://hdl.handle.net/11427/15086.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2011 Tun et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceJournal of the International AIDS Societyen_ZA
dc.source.urihttp://archive.biomedcentral.com/1758-2652/en_ZA
dc.subject.otherCytomegalovirus retinitisen_ZA
dc.subject.otherResource-poor settingsen_ZA
dc.titleCMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmaren_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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