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1.
Cristiano Nogueira Paulo A. Buckup Naercio A. Menezes Osvaldo T. Oyakawa Thais P. Kasecker Mario B. Ramos Neto José Maria C. da Silva 《PloS one》2010,5(6)
Background
Freshwaters are the most threatened ecosystems on earth. Although recent assessments provide data on global priority regions for freshwater conservation, local scale priorities remain unknown. Refining the scale of global biodiversity assessments (both at terrestrial and freshwater realms) and translating these into conservation priorities on the ground remains a major challenge to biodiversity science, and depends directly on species occurrence data of high taxonomic and geographic resolution. Brazil harbors the richest freshwater ichthyofauna in the world, but knowledge on endemic areas and conservation in Brazilian rivers is still scarce.Methodology/Principal Findings
Using data on environmental threats and revised species distribution data we detect and delineate 540 small watershed areas harboring 819 restricted-range fishes in Brazil. Many of these areas are already highly threatened, as 159 (29%) watersheds have lost more than 70% of their original vegetation cover, and only 141 (26%) show significant overlap with formally protected areas or indigenous lands. We detected 220 (40%) critical watersheds overlapping hydroelectric dams or showing both poor formal protection and widespread habitat loss; these sites harbor 344 endemic fish species that may face extinction if no conservation action is in place in the near future.Conclusions/Significance
We provide the first analysis of site-scale conservation priorities in the richest freshwater ecosystems of the globe. Our results corroborate the hypothesis that freshwater biodiversity has been neglected in former conservation assessments. The study provides a simple and straightforward method for detecting freshwater priority areas based on endemism and threat, and represents a starting point for integrating freshwater and terrestrial conservation in representative and biogeographically consistent site-scale conservation strategies, that may be scaled-up following naturally linked drainage systems. Proper management (e. g. forestry code enforcement, landscape planning) and conservation (e. g. formal protection) of the 540 watersheds detected herein will be decisive in avoiding species extinction in the richest aquatic ecosystems on the planet. 相似文献2.
Background
Result publication is the key step to improve the transparency of clinical trials.Objective
To investigate the result publication rate of Chinese trials registered in World Health Organization (WHO) primary registries.Method
We searched 11 WHO primary registries for Chinese trials records. The progress of each trial was analyzed. We searched for the full texts of result publications cited in the registration records. For completed trials without citations, we searched PubMed, Embase, Chinese Biomedical Literature Database (Chinese), China Knowledge Resource Integrated Database, and Chinese Science and Technology Periodicals Database for result publications. The search was conducted on July 14, 2009. We also called the investigators of completed trials to ask about results publication.Results
We identified 1294 Chinese trials records (428 in ChiCTR,743 in clinicaltrials.gov,55 in ISRCTN, 21 in ACTRN). A total of 443 trials had been completed. The publication rate of the Chinese trials in WHO primary registries is 35.2%(156/443).The publication rate of Chinese trials in clinicaltrials.gov, ChiCTR, ISRCTN, and ACRTN was 36.5% (53/145), 36.3% (89/245), 26.0%(9/44), and 55.6%(5/9), respectively. The publication rate of trials sponsored by industry(23.8%) was lower than that of sponsored by central and local government(31.7%), hospital(35.1%), and universities (40.7%). The publication rate for randomized trials was higher than that of cohort study and case-control study (33.2% versus 16.7%, 22.2%). The publication rate for interventional studies and observational studies was similar(33.4% versus 33.3%).Conclusion
The publication rate of the registered Chinese trials was low, with no significant difference between ChiCTR and clinicaltrials.gov. An effective mechanism is needed to promote publication of results for registered trials in China. 相似文献3.
Background
Trade in ornamental fishes represents, by far, the largest route for the importation of exotic vertebrates. There is growing pressure to regulate this trade with the goal of ensuring that species are sustainably harvested and that their point of origin is accurately reported. One important element of such regulation involves easy access to specimen identifications, a task that is currently difficult for all but specialists because of the large number of species involved. The present study represents an important first step in making identifications more accessible by assembling a DNA barcode reference sequence library for nearly half of the ornamental fish species imported into North America.Methodology/Principal Findings
Analysis of the cytochrome c oxidase subunit I (COI) gene from 391 species from 8 coral reef locations revealed that 98% of these species exhibit distinct barcode clusters, allowing their unambiguous identification. Most species showed little intra-specific variation (adjusted mean = 0.21%), but nine species included two or three lineages showing much more divergence (2.19–6.52%) and likely represent overlooked species complexes. By contrast, three genera contained a species pair or triad that lacked barcode divergence, cases that may reflect hybridization, young taxa or taxonomic over-splitting.Conclusions/Significance
Although incomplete, this barcode library already provides a new species identification tool for the ornamental fish industry, opening a realm of applications linked to collection practices, regulatory control and conservation. 相似文献4.
Margot S. Bass Matt Finer Clinton N. Jenkins Holger Kreft Diego F. Cisneros-Heredia Shawn F. McCracken Nigel C. A. Pitman Peter H. English Kelly Swing Gorky Villa Anthony Di Fiore Christian C. Voigt Thomas H. Kunz 《PloS one》2010,5(1)
Background
The threats facing Ecuador''s Yasuní National Park are emblematic of those confronting the greater western Amazon, one of the world''s last high-biodiversity wilderness areas. Notably, the country''s second largest untapped oil reserves—called “ITT”—lie beneath an intact, remote section of the park. The conservation significance of Yasuní may weigh heavily in upcoming state-level and international decisions, including whether to develop the oil or invest in alternatives.Methodology/Principal Findings
We conducted the first comprehensive synthesis of biodiversity data for Yasuní. Mapping amphibian, bird, mammal, and plant distributions, we found eastern Ecuador and northern Peru to be the only regions in South America where species richness centers for all four taxonomic groups overlap. This quadruple richness center has only one viable strict protected area (IUCN levels I–IV): Yasuní. The park covers just 14% of the quadruple richness center''s area, whereas active or proposed oil concessions cover 79%. Using field inventory data, we compared Yasuní''s local (alpha) and landscape (gamma) diversity to other sites, in the western Amazon and globally. These analyses further suggest that Yasuní is among the most biodiverse places on Earth, with apparent world richness records for amphibians, reptiles, bats, and trees. Yasuní also protects a considerable number of threatened species and regional endemics.Conclusions/Significance
Yasuní has outstanding global conservation significance due to its extraordinary biodiversity and potential to sustain this biodiversity in the long term because of its 1) large size and wilderness character, 2) intact large-vertebrate assemblage, 3) IUCN level-II protection status in a region lacking other strict protected areas, and 4) likelihood of maintaining wet, rainforest conditions while anticipated climate change-induced drought intensifies in the eastern Amazon. However, further oil development in Yasuní jeopardizes its conservation values. These findings form the scientific basis for policy recommendations, including stopping any new oil activities and road construction in Yasuní and creating areas off-limits to large-scale development in adjacent northern Peru. 相似文献5.
Rama Mishra Hans H. de Iongh Hewig Leirs Babu Ram Lamichhane Naresh Subedi Shekhar S. Kolipaka 《Ecology and evolution》2022,12(4)
The fishing cat Prionailurus viverrinus is a wetland specialist species endemic to South and Southeast Asia. Nepal represents the northern limit of its biogeographic range, but comprehensive information on fishing cat distribution in Nepal is lacking. To assess their distribution, we compiled fishing cat occurrence records (n = 154) from Nepal, available in published literature and unpublished data (2009–2020). Bioclimatic and environmental variables associated with their occurrence were used to predict the fishing cat habitat suitability using MaxEnt modeling. Fishing cat habitat suitability was associated with elevation (152–302 m), precipitation of the warmest quarter, i.e., April–June (668–1014 mm), precipitation of the driest month (4–7 mm), and land cover (forest/grassland and wetland). The model predicted an area of 4.4% (6679 km2) of Nepal as potential habitat for the fishing cat. About two‐thirds of the predicted potentially suitable habitat lies outside protected areas; however, a large part of the highly suitable habitat (67%) falls within protected areas. The predicted habitat suitability map serves as a reference for future investigation into fishing cat distribution as well as formulating and implementing effective conservation programs in Nepal. Fishing cat conservation initiatives should include habitats inside and outside the protected areas to ensure long‐term survival. We recommend conservation of wetland sites, surveys of fishing cats in the identified potential habitats, and studying their genetic connectivity and population status. 相似文献
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Objectives
To assess if a probabilistic model could be used to estimate the combined prevalence of infection with any species of intestinal nematode worm when only the separate prevalence of each species is reported, and to estimate the extent to which simply taking the highest individual species prevalence underestimates the combined prevalence.Methods
Data were extracted from community surveys that reported both the proportion infected with individual species and the combined proportion infected, for a minimum sample of 100 individuals. The predicted combined proportion infected was calculated based on the assumption that the probability of infection with one species was independent of infection with another species, so the probability of combined infections was multiplicative.Findings
Thirty-three reports describing 63 data sets from surveys conducted in 20 countries were identified. A strong correlation was found between the observed and predicted combined proportion infected (r = 0.996, P<0.001). When the observed and predicted values were plotted against each other, a small correction of the predicted combined prevalence by dividing by a factor of 1.06 achieved a near perfect correlation between the two sets of values. The difference between the single highest species prevalence and the observed combined prevalence was on average 7% or smaller at a prevalence of ≤40%, but at prevalences of 40–80%, the difference was about 12%.Conclusions
A simple probabilistic model of combined infection with a small correction factor is proposed as a novel method to estimate the number of individuals that would benefit from mass deworming when data are reported only for separate species. 相似文献8.
Background
The knowledge of both potential distribution and habitat suitability is fundamental in spreading species to inform in advance management and conservation planning. After a severe decline in the past decades, the griffon vulture (Gyps fulvus) is now spreading its breeding range towards the northwest in Spain and Europe. Because of its key ecological function, anticipated spatial knowledge is required to inform appropriately both vulture and ecosystem management.Methodology/Findings
Here we used maximum entropy (Maxent) models to determine the habitat suitability of potential and current breeding distribution of the griffon vulture using presence-only data (N = 124 colonies) in north-western Spain. The most relevant ecological factors shaping this habitat suitability were also identified. The resulting model had a high predictive performance and was able to predict species'' historical distribution. 7.5% (∼1,850 km2) of the study area resulted to be suitable breeding habitat, most of which (∼70%) is already occupied by the species. Cliff availability and livestock density, especially of sheep and goats, around 10 km of the colonies were the fundamental factors determining breeding habitat suitability for this species.Conclusions/Significance
Griffon vultures could still spread 50–60 km towards the west, increasing their breeding range in 1,782 km2. According to our results, 7.22% of the area suitable for griffon vulture will be affected by wind farms, so our results could help to better plan wind farm locations. The approach here developed could be useful to inform management of reintroductions and recovery programmes currently being implemented for both the griffon vulture and other threatened vulture species. 相似文献9.
Sébastien D. S. Pion Christoph Kaiser Fernand Boutros-Toni Amandine Cournil Melanie M. Taylor Stefanie E. O. Meredith Ansgar Stufe Ione Bertocchi Walter Kipp Pierre-Marie Preux Michel Boussinesq 《PLoS neglected tropical diseases》2009,3(6)
Objective
We sought to evaluate the relationship between onchocerciasis prevalence and that of epilepsy using available data collected at community level.Design
We conducted a systematic review and meta-regression of available data.Data Sources
Electronic and paper records on subject area ever produced up to February 2008.Review Methods
We searched for population-based studies reporting on the prevalence of epilepsy in communities for which onchocerciasis prevalence was available or could be estimated. Two authors independently assessed eligibility and study quality and extracted data. The estimation of point prevalence of onchocerciasis was standardized across studies using appropriate correction factors. Variation in epilepsy prevalence was then analyzed as a function of onchocerciasis endemicity using random-effect logistic models.Results
Eight studies from west (Benin and Nigeria), central (Cameroon and Central African Republic) and east Africa (Uganda, Tanzania and Burundi) met the criteria for inclusion and analysis. Ninety-one communities with a total population of 79,270 individuals screened for epilepsy were included in the analysis. The prevalence of epilepsy ranged from 0 to 8.7% whereas that of onchocerciasis ranged from 5.2 to 100%. Variation in epilepsy prevalence was consistent with a logistic function of onchocerciasis prevalence, with epilepsy prevalence being increased, on average, by 0.4% for each 10% increase in onchocerciasis prevalence.Conclusion
These results give further evidence that onchocerciasis is associated with epilepsy and that the disease burden of onchocerciasis might have to be re-estimated by taking into account this relationship. 相似文献10.
Mukherjee S Krishnan A Tamma K Home C Navya R Joseph S Das A Ramakrishnan U 《PloS one》2010,5(10):e13724
Background
Comparative phylogeography links historical population processes to current/ecological processes through congruent/incongruent patterns of genetic variation among species/lineages. Despite high biodiversity, India lacks a phylogeographic paradigm due to limited comparative studies. We compared the phylogenetic patterns of Indian populations of jungle cat (Felis chaus) and leopard cat (Prionailurus bengalensis). Given similarities in their distribution within India, evolutionary histories, body size and habits, congruent patterns of genetic variation were expected.Methodology/Principal Findings
We collected scats from various biogeographic zones in India and analyzed mtDNA from 55 jungle cats (460 bp NADH5, 141 bp cytochrome b) and 40 leopard cats (362 bp NADH5, 202 bp cytochrome b). Jungle cats revealed high genetic variation, relatively low population structure and demographic expansion around the mid-Pleistocene. In contrast, leopard cats revealed lower genetic variation and high population structure with a F ST of 0.86 between North and South Indian populations. Niche-model analyses using two approaches (BIOCLIM and MaxEnt) support absence of leopard cats from Central India, indicating a climate associated barrier. We hypothesize that high summer temperatures limit leopard cat distribution and that a rise in temperature in the peninsular region of India during the LGM caused the split in leopard cat population in India.Conclusions/Significance
Our results indicate that ecological variables describing a species range can predict genetic patterns. Our study has also resolved the confusion over the distribution of the leopard cat in India. The reciprocally monophyletic island population in the South mandates conservation attention. 相似文献11.
Norwegian Physicians' Knowledge of and Opinions about Evidence-Based Medicine: Cross-Sectional Study
Objective
To answer five research questions: Do Norwegian physicians know about the three important aspects of EBM? Do they use EBM methods in their clinical practice? What are their attitudes towards EBM? Has EBM in their opinion changed medical practice during the last 10 years? Do they use EBM based information sources?Design
Cross sectional survey in 2006.Setting
Norway.Participants
966 doctors who responded to a questionnaire (70% response rate).Results
In total 87% of the physicians mentioned the use of randomised clinical trials as a key aspect of EBM, while 53% of them mentioned use of clinical expertise and only 19% patients'' values. 40% of the respondents reported that their practice had always been evidence-based. Many respondents experienced difficulties in using EBM principles in their clinical practice because of lack of time and difficulties in searching EBM based literature. 80% agreed that EBM helps physicians towards better practice and 52% that it improves patients'' health. As reasons for changes in medical practice 86% of respondents mentioned medical progress, but only 39% EBM.Conclusions
The results of the study indicate that Norwegian physicians have a limited knowledge of the key aspects of EBM but a positive attitude towards the concept. They had limited experience in the practice of EBM and were rather indifferent to the impact of EBM on medical practice. For solving a patient problem, physicians would rather consult a colleague than searching evidence based resources such as the Cochrane Library. 相似文献12.
Background
How do national-level actions overlap with global priorities for conservation? Answering this question is especially important in countries with high and unique biological diversity like Colombia. Global biodiversity schemes provide conservation guidance at a large scale, while national governments gazette land for protection based on a combination of criteria at regional or local scales. Information on how a protected area network represents global and national conservation priorities is crucial for finding gaps in coverage and for future expansion of the system.Methodology/Principal Findings
We evaluated the agreement of Colombia''s protected area network with global conservation priorities, and the extent to which the network reflects the country''s biomes, species richness, and common environmental and physical conditions. We used this information to identify priority biomes for conservation. We find the dominant strategy in Colombia has been a proactive one, allocating the highest proportion of protected land on intact, difficult to access and species rich areas like the Amazon. Threatened and unique areas are disproportionately absent from Colombia''s protected lands. We highlight six biomes in Colombia as conservation priorities that should be considered in any future expansion of Colombia''s protected area network. Two of these biomes have less than 3% of their area protected and more than 70% of their area transformed for human use. One has less than 3% protected and high numbers of threatened vertebrates. Three biomes fall in both categories.Conclusions
Expansion of Colombia''s Protected Area Network should consider the current representativeness of the network. We indicate six priority biomes that can contribute to improving the representation of threatened species and biomes in Colombia. 相似文献13.
Max Lataillade Jennifer Chiarella Rong Yang Steven Schnittman Victoria Wirtz Jonathan Uy Daniel Seekins Mark Krystal Marco Mancini Donnie McGrath Birgitte Simen Michael Egholm Michael Kozal 《PloS one》2010,5(6)
Background
CASTLE compared the efficacy of atazanavir/ritonavir with lopinavir/ritonavir, each in combination with tenofovir-emtricitabine in ARV-naïve subjects from 5 continents.Objectives
Determine the baseline rate and clinical significance of TDR mutations using ultra-deep sequencing (UDS) in ARV-naïve subjects in CASTLE.Methods
A case control study was performed on baseline samples for all 53 subjects with virologic failures (VF) at Week 48 and 95 subjects with virologic successes (VS) randomly selected and matched by CD4 count and viral load. UDS was performed using 454 Life Sciences/Roche technology.Results
Of 148 samples, 141 had successful UDS (86 subtype B, 55 non-B subtypes). Overall, 30.5% of subjects had a TDR mutation at baseline; 15.6% only had TDR(s) at <20% of the viral population. There was no difference in the rate of TDRs by B (30.2%) or non-B subtypes (30.9%). VF (51) and VS (90) had similar rates of any TDRs (25.5% vs. 33.3%), NNRTI TDRs (11.1% vs.11.8%) and NRTI TDRs (24.4% vs. 25.5%). Of 9 (6.4%) subjects with M184V/I (7 at <20% levels), 6 experienced VF. 16 (11.3%) subjects had multiple TAMs, and 7 experienced VF. 3 (2.1%) subjects had both multiple TAMs+M184V, and all experienced VF. Of 14 (9.9%) subjects with PI TDRs (11 at <20% levels): only 1 experienced virologic failure. The majority of PI TDRs were found in isolation (e.g. 46I) at <20% levels, and had low resistance algorithm scores.Conclusion
Among a representative sample of ARV-naïve subjects in CASTLE, TDR mutations were common (30.5%); B and non-B subtypes had similar rates of TDRs. Subjects with multiple PI TDRs were infrequent. Overall, TDRs did not affect virologic response for subjects on a boosted PI by week 48; however, a small subset of subjects with extensive NRTI backbone TDR patterns experienced virologic failure. 相似文献14.
Megan E. Moore Fred A. Goetz Donald M. Van Doornik Eugene P. Tezak Thomas P. Quinn Jose J. Reyes-Tomassini Barry A. Berejikian 《PloS one》2010,5(9)
Background
Hybridization between coastal cutthroat trout (Oncorhynchus clarki clarki) and steelhead or rainbow trout (Oncorhynchus mykiss) has been documented in several streams along the North American west coast. The two species occupy similar freshwater habitats but the anadromous forms differ greatly in the duration of marine residence and migration patterns at sea. Intermediate morphological, physiological, and performance traits have been reported for hybrids but little information has been published comparing the behavior of hybrids to the pure species.Methodology/Principal Findings
This study used acoustic telemetry to record the movements of 52 cutthroat, 42 steelhead x cutthroat hybrids, and 89 steelhead smolts, all wild, that migrated from Big Beef Creek into Hood Canal (Puget Sound, Washington). Various spatial and temporal metrics were used to compare the behavior of the pure species to their hybrids. Median hybrid residence time, estuary time, and tortuosity values were intermediate compared to the pure species. The median total track distance was greater for hybrids than for either cutthroat or steelhead. At the end of each track, most steelhead (80%) were located near or north of the Hood Canal, as expected for this seaward migrating species, whereas most cutthroat (89%) were within 8 kilometers of the estuary. Most hybrids (70%) were detected leaving Hood Canal, though a substantial percentage (20%) remained near the Big Beef Creek estuary. More hybrids (7.5%) than pure cutthroat (4.5%) or steelhead (0.0%) were last detected in the southern reaches of Hood Canal.Conclusions/Significance
Given the similarity in freshwater ecology between the species, differences in marine ecology may play an important role in maintaining species integrity in areas of sympatry. 相似文献15.
Charles M. Francis Alex V. Borisenko Natalia V. Ivanova Judith L. Eger Burton K. Lim Antonio Guillén-Servent Sergei V. Kruskop Iain Mackie Paul D. N. Hebert 《PloS one》2010,5(9)
Background
Southeast Asia is recognized as a region of very high biodiversity, much of which is currently at risk due to habitat loss and other threats. However, many aspects of this diversity, even for relatively well-known groups such as mammals, are poorly known, limiting ability to develop conservation plans. This study examines the value of DNA barcodes, sequences of the mitochondrial COI gene, to enhance understanding of mammalian diversity in the region and hence to aid conservation planning.Methodology and Principal Findings
DNA barcodes were obtained from nearly 1900 specimens representing 165 recognized species of bats. All morphologically or acoustically distinct species, based on classical taxonomy, could be discriminated with DNA barcodes except four closely allied species pairs. Many currently recognized species contained multiple barcode lineages, often with deep divergence suggesting unrecognized species. In addition, most widespread species showed substantial genetic differentiation across their distributions. Our results suggest that mammal species richness within the region may be underestimated by at least 50%, and there are higher levels of endemism and greater intra-specific population structure than previously recognized.Conclusions
DNA barcodes can aid conservation and research by assisting field workers in identifying species, by helping taxonomists determine species groups needing more detailed analysis, and by facilitating the recognition of the appropriate units and scales for conservation planning. 相似文献16.
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Anna M. van Eijk Kim A. Lindblade Frank Odhiambo Elizabeth Peterson Daniel H. Rosen Diana Karanja John G. Ayisi Ya Ping Shi Kubaje Adazu Laurence Slutsker 《PLoS neglected tropical diseases》2009,3(1)
Background
Geohelminth infections are common in rural western Kenya, but risk factors and effects among pregnant women are not clear.Methodology
During a community-based cross-sectional survey, pregnant women were interviewed and asked to provide a blood sample and a single fecal sample. Hemoglobin was measured and a blood slide examined for malaria. Geohelminth infections were identified using the concentration and Kato-Katz method.Results
Among 390 participants who provided a stool sample, 76.2% were infected with at least one geohelminth: 52.3% with Ascaris lumbricoides, 39.5% with hookworm, and 29.0% with Trichuris trichiura. Infection with at least one geohelminth species was associated with the use of an unprotected water source (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI] 1.1–3.0) and the lack of treatment of drinking water (AOR 1.8, 95% CI 1.1–3.1). Geohelminth infections were not associated with clinical symptoms, or low body mass index. A hookworm infection was associated with a lower mid upper arm circumference (adjusted mean decrease 0.7 cm, 95% CI 0.3–1.2 cm). Hookworm infections with an egg count ≥1000/gram feces (11 women) were associated with lower hemoglobin (adjusted mean decrease 1.5 g/dl, 95% CI 0.3–2.7). Among gravidae 2 and 3, women with A. lumbricoides were less likely to have malaria parasitemia (OR 0.4, 95% CI 0.2–0.8) compared to women without A. lumbricoides, unlike other gravidity groups.Conclusion
Geohelminth infections are common in this pregnant population; however, there were few observed detrimental effects. Routine provision of antihelminth treatment during an antenatal clinic visit is recommended, but in this area an evaluation of the impact on pregnancy, malaria, and birth outcome is useful. 相似文献19.
Stephanie M. Topp Julien M. Chipukuma Mark Giganti Linah K. Mwango Like M. Chiko Bushimbwa Tambatamba-Chapula Chibesa S. Wamulume Stewart Reid 《PloS one》2010,5(7)
Introduction
HIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics.Methods
Integration involved three key modifications: i) amalgamation of space and patient flow; ii) standardization of medical records and iii) introduction of routine provider initiated testing and counseling (PITC). Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Qualitative data on patient/provider perceptions was also collected.Findings
Provider and patient interviews at both sites indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. Over six months in Clinic 1, PITC was provided to 2760 patients; 1485 (53%) accepted testing, 192 (13%) were HIV positive and 80 (42%) enrolled. Median OPD patient-provider contact time increased 55% (6.9 vs. 10.7 minutes; p<0.001) and decreased 1% for ART patients (27.9 vs. 27.7 minutes; p = 0.94). Median waiting times increased by 36 (p<0.001) and 23 minutes (p<0.001) for ART and OPD patients respectively. In Clinic 2, PITC was offered to 1510 patients, with 882 (58%) accepting testing, 208 (24%) HIV positive and 121 (58%) enrolled. Median OPD patient-provider contact time increased 110% (6.1 vs. 12.8 minutes; p<0.001) and decreased for ART patients by 23% (23 vs. 17.7 minutes; p<0.001). Median waiting times increased by 47 (p<0.001) and 34 minutes (p<0.001) for ART and OPD patients, respectively.Conclusions
Integrating vertical ART and OPD services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is urgently required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalizability. 相似文献20.