Abstract
Purpose :
Cytomegalovirus (CMV) retinitis remains an important cause of blindness for people living with HIV/AIDS in Southeast Asia. Although it is recommended that patients with HIV and a CD4 under 100 cells/µl receive a fundus examination to screen for CMV retinitis, adherence is typically poor in northern Thailand. One potential reason is the need for the patient to return for a separate visit to the ophthalmologist. To address this, a hospital in northern Thailand installed a fundus camera in the HIV clinic and asked providers to have all patients with a CD4 < 100 photographed. Here we assess the number of eligible patients who were screened with fundus photography relative to a historical control period.
Methods :
A tabletop retina camera was installed at the HIV clinic of a tertiary hospital in Chiang Mai, Thailand. Patients aged ≥18 years with HIV and CD4+<100 were offered nonmydriatic fundus photography from October 2014-March 2016. The hospital laboratory records were reviewed to identify all patients who had HIV and a CD4<100 from August 2012 until March 2016, and the clinical records were reviewed to determine if a participant had a retina examination by an ophthalmologist.
Results :
Over the period prior to installation of the fundus camera, 348 patients had a CD4<100 (mean age 37 ± 10 years; 58% male; mean CD4 count 45 ± 32 cells/µl). Over the period after installation of the camera, 334 patients had a CD4<100 (mean age 38 ± 12 years; 63% male; mean CD4 count 40 ± 28 cells/µl). During the pre-camera period, 24 of 348 (7%) patients received a retinal examination by a hospital ophthalmologist. After installation of the fundus camera, 134 of 334 (39%) were screened for CMV retinitis either via photography or an ophthalmologist exam (P < 0.001 comparing the two time periods).
Conclusions :
Installation of a fundus camera within an HIV clinic resulted in a 5-fold increase in the number of patients receiving retinal screening for CMV retinitis, although even with the camera, adherence was only 39%. Having a fundus camera in the clinic may have increased the likelihood that the HIV providers remembered the importance of retinal screening, while also reducing the logistical complexities of having to return for a separate appointment with the ophthalmologist. Additional measures are needed to further increase adherence to retinal screening examinations for people living with HIV in this setting.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.