TY - JOUR
T1 - Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas
T2 - Results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration
AU - the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration
AU - Duda, Stephany N.
AU - Farr, Amanda M.
AU - Lindegren, Mary Lou
AU - Blevins, Meridith
AU - Wester, C. William
AU - Wools-Kaloustian, Kara
AU - Ekouevi, Didier K.
AU - Egger, Matthias
AU - Hemingway-Foday, Jennifer
AU - Cooper, David A.
AU - Moore, Richard D.
AU - McGowan, Catherine C.
AU - Nash, Denis
AU - Saphonn, Vonthanak
AU - Saramony, Sarun
AU - Han, Ning
AU - Lee, Man Po
AU - Zhang, Fujie
AU - Bele, Vivek
AU - Pujari, Sanjay
AU - Merati, Tuti
AU - Ramadian, Okki
AU - Yuliana, Flora
AU - Yunihastuti, Evy
AU - Oka, Shinichi
AU - Takano, Misao
AU - Kajindran, Anna
AU - Kamarulzaman, Adeeba
AU - Low, Lee Lee
AU - Sim, Benedict L.H.
AU - Capistrano, Rowena
AU - Ditangco, Rossana
AU - Kuo, Lou Hui
AU - Wong, Wing Wai
AU - Chaiwarith, Romanee
AU - Khongpattanayothin, Mana
AU - Kiertiburanakul, Sasisopin
AU - Kotarathititum, Wilai
AU - Phanuphak, Praphan
AU - Piyavong, Bucha
AU - Fou, Estelle
AU - Ng, Oon Tek
AU - Choi, Jun Yong
AU - Han, Sang Hoon
AU - Carr, Andrew
AU - Chuah, John
AU - Dickson, Bridget
AU - Hoy, Jennifer
AU - Ji, Jing
AU - Norris, Richard
N1 - Publisher Copyright:
© 2014 Duda SN et al; licensee International AIDS Society.
PY - 2014
Y1 - 2014
N2 - Introduction: HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. Methods: Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. Results: Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. Conclusions: This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.
AB - Introduction: HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. Methods: Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. Results: Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. Conclusions: This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.
KW - Clinic characteristics
KW - Comprehensive care
KW - HIV care capacity
KW - HIV/AIDS
KW - Resource-limited settings
UR - http://www.scopus.com/inward/record.url?scp=84942501743&partnerID=8YFLogxK
U2 - 10.7448/IAS.17.1.19045
DO - 10.7448/IAS.17.1.19045
M3 - Article
C2 - 25516092
AN - SCOPUS:84942501743
SN - 1758-2652
VL - 17
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 1
M1 - 19045
ER -