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J Int AIDS Soc. 2014 Dec 15;17:19045. doi: 10.7448/IAS.17.1.19045. eCollection 2014.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration.

Collaborators (334)

Saphonn V, Saramony S, Han N, Lee MP, Zhang F, Bele V, Pujari S, Merati T, Ramadian O, Yuliana F, Yunihastuti E, Oka S, Takano M, Kajindran A, Kamarulzaman A, Low LL, Sim BL, Capistrano R, Ditangco R, Kuo LH, Wong WW, Chaiwarith R, Khongpattanayothin M, Kiertiburanakul S, Kotarathititum W, Phanuphak P, Piyavong B, Fou E, Ng OT, Choi JY, Han SH, Carr A, Chuah J, Dickson B, Hoy J, Ji J, Norris R, Templeton D, Watson K, Bendall C, Cooper DA, Jiamsakul A, Law MG, McManus H, Durier N, Petersen B, Sohn AH, Rodriguez B, Moore RD, Gill M, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Bebawy S, Turner M, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, McKaig RG, Justice AC, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing Y, Golub E, Modur S, Wong C, Mendes A, Masys DR, Minor B, Wehbe F, Cahn P, Krolewiecki A, Cesar C, Schechter M, Faulhaber JC, Wolff M, Cortes C, Pape JW, Marcelin A, Padgett D, Sierra-Madero J, Vega YC, Gotuzzo E, Akam W, Urayeneza E, Uwingabiye R, Modeste K, Patou W, Coucou E, Kassamina K, Mpukela MA, Mafutaming K, Munyungu N, Kabwe J, Mbaya M, Lufindusu S, Balimba A, Susan B, Molu BM, Blessing B, Niyongabo T, Nindagiye E, Dusengamungu C, Manariyo M, Ayaya S, Diero L, Yiannoutsos C, Musick BS, Lyamuya R, Mbaula MF, Mtiro H, Wilfest W, Mhinga, Maruchu IA, Ssali J, Ssemakadde M, Deo W, Mubiru M, Masaba JP, Musaazi J, Bwana M, Musinguzi N, Mbidde M, Kalanzi H, Kambugu AD, Orama R, Mboya E, Braitstein P, Sang E, Chebet J, Chelobei F, Josphat M, Ariya P, Namaemba J, Munyisi C, Ototo R, Caroline K, Busaka O, Bett LM, Simatwa L, Hosea S, Nancy W, Boit L, Biyegon J, Peter C, Paron M, Nandi S, Wycliffe KN, Otieno J, Omolo K, Mukhwana W, Koech J, Ndiege DO, Owiti J, Wasing'a E, Owengah E, Juma EN, Kulzer J, Odhiambo B, Tanser F, Hoffmann C, Chi B, Naniche D, Wood R, Stinson K, Fatti G, Phiri S, Giddy J, Chimbetete C, Malisita K, Eley B, Hobbins M, Kamenova K, Faturiyele O, Fox M, Prozesky H, Technau K, Sawry S, Egger M, Bohlius J, Blaser N, Estill J, Keiser O, Wandeler G, Salazar-Vizcaya L, Haas A, Ballif M, Rohner E, Wyss N, Baranczuk Z, Goodwin K, Ostinelli CH, Davies MA, Boulle A, Campbell L, Cornell M, Johnson L, Maxwell N, Myer L, Schomaker M, Porter M, Eley B, Dabis F, Bissagnene E, Arrivé E, Coffie P, Ekouevi D, Jaquet A, Leroy V, Lewden C, de Rekeneire N, Sasco AJ, Zannou DM, Ahouada C, Akakpo J, Ahomadegbé C, Bashi J, Gougounon-Houéto A, Azon-Kouanou A, Houngbé F, Sehonou J, Drabo J, Bognounou R, Dienderé A, Traore E, Zoungrana L, Zerbo B, Sawadogo AB, Zoungrana J, Héma A, Soré I, Bado G, Tapsoba A, Messou E, Gnokoro JC, Koné M, Kouakou GM, Bosse CA, Brou K, Assi AI, Chenal H, Hawerlander D, Soppi F, Minga A, Abo Y, Yoboue JM, Eholié SP, Amego MD, Andavi V, Diallo Z, Ello F, Tanon AK, Koule SO, Anzan KC, Guehi C, Wejse C, Da Silva ZJ, Paulo J, Rodrigues A, da Silva D, Medina C, Oliviera-Souto I, Østergaard L, Laursen A, Sodemann M, Aaby P, Fomsgaard A, Erikstrup C, Eugen-Olsen J, Leuenberger D, Hebelamou J, Maïga MY, Diakité FF, Kalle A, Katile D, Traore HA, Minta D, Cissé T, Dembelé M, Doumbia M, Fomba M, Kaya AS, Traoré AM, Traoré H, Toure AA, Charurat M, Kwaghe V, Ajayi S, Alim G, Dapiap S, Otu, Igbinoba F, Benson O, Adebamowo C, James J, Obaseki, Osakede P, Olasode J, Seydi M, Sow PS, Diop B, Manga NM, Tine JM, Bassabi CC, Patassi A, Kotosso A, Kariyare BG, Gbadamassi G, Komi A, Mensah-Zukong KE, Pakpame P.

Author information

1
Department of Biomedical Informatics, Vanderbilt School of Medicine, Nashville, TN, USA; stephany.duda@vanderbilt.edu.
2
Department of Life Sciences, Truven Health Analytics, Cambridge, MA, USA; School of Public Health, City University of New York, New York, NY, USA.
3
Department of Pediatrics, Vanderbilt School of Medicine, Nashville, TN, USA; Department of Health Policy, Vanderbilt School of Medicine, Nashville, TN, USA.
4
Department of Biostatistics, Vanderbilt School of Medicine, Nashville, TN, USA; Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
5
Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA; Department of Medicine, Division of Infectious Diseases, Vanderbilt School of Medicine, Nashville, TN, USA.
6
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
7
Université de Bordeaux, ISPED, centre Inserm U897 Épidémiologie-Biostatistique, 33000, Bordeaux, France; Programme PAC-CI, Site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire; Université de Lomé, Faculté des Sciences de la Santé, Départment de Santé Publique, Lomé, Togo.
8
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
9
Research Triangle Institute, Raleigh, NC, USA.
10
Kirby Institute, University of New South Wales, Sydney, Australia.
11
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA.
12
Department of Medicine, Division of Infectious Diseases, Vanderbilt School of Medicine, Nashville, TN, USA.
13
Epidemiology and Biostatistics Program, Hunter College, City University of New York, New York, NY, USA; Doctor of Public Health Programs (CUNY SPH), School of Public Health, City University of New York, New York, NY, USA.

Abstract

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.

KEYWORDS:

HIV care capacity; HIV/AIDS; clinic characteristics; comprehensive care; resource-limited settings

PMID:
25516092
PMCID:
PMC4268491
DOI:
10.7448/IAS.17.1.19045
[Indexed for MEDLINE]
Free PMC Article

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