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L. M. Rangwala, B. Alemayehu, R. M. Lieberman; Design, Implementation, and Initial Results of an HIV Ophthalmic Screening Service in a Regional Ethiopian Hospital. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1541.
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To describe the design and implementation of ophthalmic protocols for HIV positive patients at a regional Ethiopian hospital. To evaluate prevalence of ophthalmic disease in these patients.
In collaboration with Ethiopian ophthalmic staff, the following protocols were designed: referral and screening of all HIV positive patients, diagnosis of ophthalmic conditions/opportunistic infections, appropriate treatment and follow-up. Implementation involved training of staff, direct observation of the protocols in use, with continued revision of protocols as needed. Retrospective chart review of the initial cohort was performed to include the following data: age, gender, CD-4+ counts, presence/absence of anti-retroviral treatment (ART), best corrected visual acuity (BCVA), time between diagnosis of HIV and ophthalmic screening, and presence/absence of ophthalmic disease.
Between 2/6/08 and 9/22/08, 505 new patients were screened in the HIV clinic, and 72 sent to ophthalmology. Of these, 46 /72 (63.9%) were found to have HIV retinopathy or a normal exam; 26 /72 (36.1%) were diagnosed with ophthalmic disease. Time between diagnosis of HIV and initial ophthalmology visit ranged from 21 to 707 days (mean 342.2). CD-4+ range < 10 - 303; 25 of 26 patients were on ART. Initial BCVA ranged from 6/6 to NLP. Infectious etiologies were as follows: CMV retinitis 5 (6.9%), h. zoster ophthalmicus 5 (6.9%), optic neuropathy 4 (5.6%), toxoplasmosis 1(1.4%), anterior uveitis 4 (5.6%), squamous cell carcinoma 4.2% (3), m. contagiosum 4 (5.6%), other (episcleritis, bacterial keratitis, diabetic retinopathy, preseptal cellulitis, CN VI palsy, candida retinitis, and trachoma) 7 (9.7%).
Protocols designed to efficiently screen for and treat ophthalmic manifestations of AIDS were created for a regional Ethiopian hospital. Initial results demonstrate the prevalence of a wide variety of ocular disease. Challenges include targeting and training of personnel, adaptation of protocols to improve referral, diagnosis and treatment, and improving timely referral of patients to the eye clinic.
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