Journal Article > LetterFull Text
Lancet Global Health. 2014 February 1; Volume 2 (Issue 2); e76-e77.; DOI:10.1016/S2214-109X(13)70174-8
Heiden D, Saranchuk P, Tun NL, Audoin B, Cohn J, et al.
Lancet Global Health. 2014 February 1; Volume 2 (Issue 2); e76-e77.; DOI:10.1016/S2214-109X(13)70174-8
Journal Article > CommentaryFull Text
Bull World Health Organ. 2014 September 22; Volume 92 (Issue 12); 903-908.; DOI:10.2471/BLT.14.142372
Heiden D, Tun NL, Maningding E, Heiden M, Rose-Nussbaumer J, et al.
Bull World Health Organ. 2014 September 22; Volume 92 (Issue 12); 903-908.; DOI:10.2471/BLT.14.142372
PROBLEM
Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed.
APPROACH
We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation.
LOCAL SETTING
Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease.
RELEVANT CHANGES
Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data.
LESSONS LEARNT
Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries.
Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed.
APPROACH
We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation.
LOCAL SETTING
Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease.
RELEVANT CHANGES
Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data.
LESSONS LEARNT
Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries.
Journal Article > ResearchFull Text
Open Forum Infect Dis. 2019 June 14
Ei WLSS, Soe KT, Hilbig A, Murray J, Heiden D
Open Forum Infect Dis. 2019 June 14
A retrospective review of diagnosis of cytomegalovirus retinitis (CMVR) before and after
introduction of routine immediate eye examination among AIDS patient in Myanmar with an
absolute CD4 T cell count <100 cells/microliter demonstrated an increased detection of
CMVR from 1.1% (14/1233) to 10.7% (65/608), an improvement of approximately ten-fold.
Diagnosis of CMVR was achieved a mean of 2 days after clinic enrollment.
introduction of routine immediate eye examination among AIDS patient in Myanmar with an
absolute CD4 T cell count <100 cells/microliter demonstrated an increased detection of
CMVR from 1.1% (14/1233) to 10.7% (65/608), an improvement of approximately ten-fold.
Diagnosis of CMVR was achieved a mean of 2 days after clinic enrollment.