title: Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study.
abstract: OBJECTIVE
  To implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland.
  
  
  METHODS
  Operational research.
  
  
  METHODS
  District hospital in Southern Africa.
  
  
  METHODS
  1171 patients with a previous diagnosis of HIV. A baseline patient group consisted of the first 200 patients using the service. Two follow-up groups were defined: group 1 was all patients recruited from April to June 2009 and group 2 was 200 patients recruited in February 2010.
  
  
  METHODS
  Introduction of pre-ART care-a package of interventions, including counselling; regular review; clinical staging; timely initiation of ART; social and psychological support; and prevention and management of opportunistic infections, such as tuberculosis.
  
  
  METHODS
  Proportion of patients assessed for ART eligibility, proportion of eligible patients who were started on ART and proportion receiving defined evidence-based interventions (including prophylactic co-trimoxazole and tuberculosis screening).
  
  
  RESULTS
  Following the implementation of the pre-ART service, the proportion of patients receiving defined interventions increased; the proportion of patient being assessed for ART eligibility significantly increased (baseline: 59%, group 1: 64%, group 2: 76%; p=0.001); the proportion of ART-eligible patients starting treatment increased (baseline: 53%, group 1: 81%, group: 2, 81%; p<0.001) and the median time between patients being declared eligible for ART and initiation of treatment significantly decreased (baseline: 61 days, group 1: 39 days, group 2: 14 days; p<0.001).
  
  
  CONCLUSIONS
  This intervention was part of a shift in the model of care from a fragmented acute care model to a more comprehensive service. The introduction of structured pre-ART was associated with significant improvements in the assessment, management and timeliness of initiation of treatment for patients with HIV.
authors.affiliation: Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: David
authors.initials: D
authors.lastname: Burtle
authors.forename: William
authors.initials: W
authors.lastname: Welfare
authors.forename: Susan
authors.initials: S
authors.lastname: Elden
authors.forename: Canaan
authors.initials: C
authors.lastname: Mamvura
authors.forename: Joris
authors.initials: J
authors.lastname: Vandelanotte
authors.forename: Emily
authors.initials: E
authors.lastname: Petherick
authors.forename: John
authors.initials: J
authors.lastname: Walley
authors.forename: John
authors.initials: J
authors.lastname: Wright