Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We\nevaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and\nretention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+\nmothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinatingmultidisciplinary\ncare. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and\nafter implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital\nteams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementersââ?¬â?¢\nperspective. Results.Opportunistic infections decreased by 24%(95%CI: 14%ââ?¬â??34%) and 11.3% of patients improved in CDC clinical\nstage. Average per-patient costs decreased by $133/patient/year (95% CI: $29ââ?¬â??$249). The intervention, compared to business-asusual\nstrategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible\npatients to receive therapy.We recommended the intervention be implemented in all HIV service facilities in Nicaragua.
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