Reduced mortality and morbidity benefit with the positive impactts of a health community
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Explanation:
The burden of morbidity and mortality associated with HIV infection has decreased over the past decade as access to ART has increased. Since 2003, the annual number of people dying from AIDS-related causes has declined by 43%, with 1.1 million AIDS-related deaths reported in 2015 (1). This decline is largely the result of expanded access to ART and an evolution towards treating people earlier in the course of HIV infection (2); however, the decline in AIDS-related deaths appears to have plateaued during the past three years (1).
In 2015, WHO recommended that all people living with HIV start ART irrespective of clinical or immune status, and most national guidelines have adopted this recommendation (3). This shift towards earlier initiation of ART, together with improved access to HIV testing and treatment, has led to an overall improvement in health status at the start of ART (4), as reflected by a gradual increase in the median CD4 cell count at the start of ART in most settings (5).
Despite this progress, up to half of people living with HIV continue to present to care with advanced HIV disease – defined by WHO as having a CD4 cell count <200 cells/mm3 or a WHO clinical stage 3 or 4 disease (6). People presenting with advanced HIV disease are at high risk of death, even after starting ART, with the risk increasing with decreasing CD4 cell count, especially with CD4 cell count <100 cells/mm3 (7–9). Advanced HIV disease is also associated with increased health-care costs (10).
The scaling up of ART has benefited from a public health approach that has emphasized standardized, simplified treatment protocols along with decentralization, integration and task sharing to support service delivery (11). To date, service delivery within a public health approach in resource-limited settings has provided little differentiation of how ART is provided to people with differing clinical needs.
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The study also demonstrated that health professionals involved in newborn care underestimate the impact of hypothermia on neonatal ...