RESUMEN
The HIV treatment landscape in low- and middle-income countries (LMICs) is rapidly evolving, exemplified by the expansion of differentiated service delivery (DSD) during the coronavirus disease (COVID-19) pandemic. Long-acting products represent a new frontier that will require a significant redesign of health systems. It is critical to understand service delivery and product preferences of people living with HIV (PLHIV) and ensure evidence generation is guided by community priorities. We conducted a scoping review to identify gaps among preference studies and inform future research. Peer-reviewed articles published from January 2014-May 2022 reporting acceptability or preference data from PLHIV or caregivers for one or more service delivery or product attribute were eligible. Service delivery studies were restricted to LMIC populations while product studies had no geographical restrictions. Based on gaps identified, we consulted advocates to develop community-led research agenda recommendations. Of 6,493 studies identified, 225 studies on service delivery attributes and 47 studies on product preferences were eligible. The most frequently studied delivery models were integration (n = 59) and technology-based interventions (n = 55). Among product literature, only 15 studies included LMIC populations. Consultation with advocates highlighted the need for research on long-acting products, including among pediatric, pregnant, and breastfeeding PLHIV, PLHIV on second-line regimens, and key populations. Consultation also emphasized the need to understand preferences on clinic visit frequency, side effects, and choice. While the preference literature has expanded, gaps remain around long-acting regimens and their delivery. To fill these gaps, the research agenda must be guided by the priorities of communities of PLHIV.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/epidemiología , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Adulto , Edad de Inicio , Anemia de Células Falciformes/diagnóstico , Anemia de Células Falciformes/genética , Foramen Oval Permeable/diagnóstico , Genotipo , Hemoglobina Falciforme/genética , HumanosRESUMEN
We report a challenging case of a 16-year-old male who presented with thrombocytopenia and eluded a definitive diagnosis for over 2 years. He was initially diagnosed with a viral illness, although he later developed adenopathy and splenomegaly. An evaluation by an oncologist was unrevealing. He worked on a farm with livestock exposure and was later diagnosed with an atypical, zoonotic infection. Despite appropriate antibiotic therapy, the thrombocytopenia and splenomegaly persisted. Further evaluation revealed that he has a relatively common immunologic disorder. He is currently doing well on appropriate therapy for this disorder.