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.
Bibliographical noteFunding Information:
The International epidemiologic Databases to Evaluate AIDS (IeDEA) consortium (http://www.iedea.org) is a research network of HIV care and treatment programmes in seven geographical regions: Asia-Pacific, the Caribbean/Latin America, North America, Central Africa, East Africa, Southern Africa and West Africa [26·30]. Each IeDEA region has an independent data centre and governance structure, although the regions collaborate on cross-region projects. IeDEA is funded by the US National Institutes of Health (NIH) to address key clinical and operational research questions that require data on large numbers of patients receiving care across a spectrum of clinical care settings.
Wibina Patou, Ebondo Coucou, Kumbu Kassamina, Marie-Agnès Mpukela, Kambale Mafutaming, Nadine Munyungu, Jean Kabwe, Marcel Mbaya, Sylvie Lufindusu, Ashu Balimba, Bokeng Susan, Brigitte Mfangam Molu, Bongason Blessing, Théodore Niyongabo, Emmanuel Nindagiye, Cyrille Dusengamungu, Marcel Manariyo IeDEA East Africa: Samuel Ayaya, Lameck Diero, Constantin Yiannoutsos, Beverly S. Musick, Rita Lyamuya, Mayanga Francis Mbaula, Hussein Mtiro, Wilialfa Wilfest, Mhinga, Isaria A. Maruchu, John Ssali, Matthew Ssemakadde, Wabwire Deo, Michael Mubiru, J.P.M Masaba, Joseph Musaazi, Mwebesa Bwana, Nicholas Musinguzi, Mary Mbidde, Harriet Kalanzi, Andrew D. Kambugu, Richard Orama, Emma Mboya, Paula Braitstein, Edwin Sang, Janet Chebet, Francis Chelobei, Maiyo Josphat, Patrick Ariya, Jentrix Namaemba, Consolata Munyisi, Rachel Ototo, Kaibei Caroline, Oscar Busaka, Lynn Mildred Bett, Lilian Simatwa, Some Hosea, Wamboi Nancy, Lilian Boit, James Biyegon, Chege Peter, Moses Paron, Susan Nandi, Kivairo Ngadi Wycliffe, Juliana Otieno, Kennedy Omolo, Walter Mukhwana, Julius Koech, David Oyuko Ndiege, John Owiti, Edwin Wasing’a, Evelyne Owengah, Erick N. Juma, Jayne Kulzer, Bernard Odhiambo IeDEA Southern Africa: Frank Tanser, Africa Centre for Health and Population Studies, University of Kwazulu-Natal, Somkhele, South Africa; Christopher Hoffmann, Aurum Institute for Health Research, Johannesburg, South Africa; Benjamin Chi, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Denise Naniche, Centro de Investigac¸ão em Saúde de Manhic¸a, Manhic¸a, Mozambique; Robin Wood, Desmond Tutu HIV Centre (Gugulethu and Masiphumelele clinics), Cape Town, South Africa; Kathryn Stinson, Khayelitsha ART Programme and Médecins Sans Frontiéres, Cape Town, South Africa; Geoffrey Fatti, Kheth’Impilo Programme, South Africa; Sam Phiri, Lighthouse Trust Clinic, Lilongwe, Malawi; Janet Giddy, McCord Hospital, Durban, South Africa; Cleophas Chimbetete, Newlands Clinic, Harare, Zimbabwe; Kennedy Malisita, Queen Elizabeth Hospital, Blantyre, Malawi; Brian Eley, Red Cross War Memorial Children’s Hospital and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Michael Hobbins, SolidarMed SMART Programme, Pemba Region, Mozambique; Kamelia Kamenova, SolidarMed SMART Programme, Masvingo, Zimbabwe; Olatunbosun Faturiyele, SolidarMed SMART Programme, Maseru, Lesotho; Matthew Fox, Themba Lethu Clinic, Johannesburg, South Africa; Hans Prozesky, Tygerberg Academic Hospital, Stellenbosch, South Africa; Karl Technau, Empilweni Clinic, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa; Shobna Sawry, Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Soweto, South Africa. Regional Data Centers: Matthias Egger (Principal Investigator), Julia Bohlius, Nello Blaser, Janne Estill, Olivia Keiser, Gilles Wandeler, Luisa Salazar-Vizcaya, Andreas Haas, Marie Ballif, Eliane Rohner, Natascha Wyss, Zofia Baranczuk, Kelly Goodwin & Cam Ha Dao Ostinelli, Institute of Social and Preventative Medicine, University of Bern, Switzerland; Mary-Ann Davies (Principal Investigator), Andrew Boulle, Lucy Campbell, Morna Cornell, Leigh Johnson, Nicola Maxwell, Landon Myer, Michael Schomaker. Mireille Porter & Brian Eley, Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa. IeDEA West Africa: Executive Committee*: Franc¸ois Dabis (Principal Investigator, Bordeaux, France), Emmanuel Bissagnene (Co-Principal Investigator, Abidjan, Côte d’Ivoire), Elise Arrivé (Bordeaux, France), Patrick Coffie (Abidjan, Côte d’Ivoire), Didier Ekouevi (Abidjan, Côte d’Ivoire), Antoine Jaquet (Bordeaux, France), Valériane Leroy (Bordeaux, France), Charlotte Lewden (Bordeaux, France), Nathalie de Rekeneire (Bordeaux, France), Annie J Sasco (Bordeaux, France). Participating sites (*members of the Steering Committee, §members of the Executive Committee): Benin, Cotonou: Djimon Marcel Zannou*, Carin Ahouada, Jocelyn Akakpo, Christelle Ahomadegbé, Jules Bashi, Alice Gougounon-Houéto, Angèle Azon-Kouanou, Fabien Houngbé, Jean Sehonou (CNHU Hubert Maga). Burkina Faso: Joseph Drabo*, René Bognounou, Arnaud Dienderé, Eliezer Traore, Lassane Zoungrana, Béatrice Zerbo (CHU Yalgado, Ouagadougou), Adrien Bruno Sawadogo*§, Jacques Zoungrana, Arsène Héma, Ibrahim Soré, Guillaume Bado, Achille Tapsoba (CHU Souro Sanou, Bobo Dioulasso) Côte d’Ivoire, Abidjan: Eugène Messou*, Joachim Charles Gnokoro, Mamadou Koné, Guillaume Martial Kouakou, (ACONDA-CePReF); Clarisse Amani Bosse*, Kouakou Brou, Achi Isidore Assi (ACONDA-MTCT-Plus); Henri Chenal*, Denise Hawerlander, Franck Soppi (CIRBA); Albert Minga*, Yao Abo, Jean-Michel Yoboue (CMSDS/CNTS); Serge Paul Eholié*§, Mensah Deborah Noelly Amego, Viviane Andavi, Zelica Diallo, Frédéric Ello, Aristophane Koffi Tanon (SMIT, CHU de Treichville), Serge Olivier Koule*, Koffi Charles Anzan, Calixte Guehi (USAC, CHU de Treichville); Guinea-Bissau: Christian Wejse*§, Zacarias José Da Silva*, Joao Paulo (Bandim Health Project), The Bissau HIV cohort study group: Amabelia Rodrigues (Bandim Health Project), David da Silva (National HIV program Bissau), Candida Medina (Hospital National Simao Mendes, Bissau), Ines Oliviera-Souto (Bandim Health Project), Lars Østergaard (Department of Infectious Diseases, Aarhus University Hospital), Alex Laursen (Department of Infectious Diseases, Aarhus University Hospital), Morten Sode-mann (Department of Infectious Diseases, Odense University Hospital), Peter Aaby (Bandim Health Project), Anders Fomsgaard (Department of Virology, Statens Serum Institut, Copenhagen), Christian Erikstrup (Department of Clinical Immunology), Jesper Eugen-Olsen (Department of Infectious Diseases, Hvidovre Hospital, Copenhagen). Guinea: David Leuenberger*, Jean Hebelamou§ (Centre Medical Macenta). Mali, Bamako: Moussa Y Maïga*§, Fatoumata Fofana Diakité, Abdoulaye Kalle, Drissa Katile (CH Gabriel Toure), Hamar Alassane Traore*, Daouda Minta*, Tidiani Cissé, Mamadou Dembelé, Mohammed Doumbia, Mahamadou Fomba, Assétou Soukho Kaya, Abdoulaye M Traoré, Hamady Traoré, Amadou AbathinaToure(CHPointG).Nigeria:ManCharurat*(UMB/IHV),VivianKwaghe*§, Samuel Ajayi, Georgina Alim, Stephen Dapiap, Otu (UATH, Abuja), Festus Igbinoba (National Hospital Abuja), Okwara Benson*, Clément Adebamowo*, Jesse James, Obaseki, Philip Osakede (UBTH, Benin City), John Olasode (OATH, Ile-Ife). Senegal, Dakar: Moussa Seydi*§, Papa Salif Sow, Bernard Diop, Noël Magloire Manga, Judicael Malick Tine§, Coumba Cissé Bassabi (SMIT, CHU Fann), Togo, Lomé: Akessiwe Patassi*§, Awérou Kotosso, Benjamin Goilibe Kariyare, Gafarou Gbada-massi, Agbo Komi, Kankoé Edem Mensah-Zukong, Pinuwe Pakpame (CHU Tokoin/ Sylvanus Olympio). Coordinating Centre: ISPED, Univ Bordeaux Segalen, Bordeaux, France Regional Office: PAC-CI, Abidjan, Côte d’Ivoire Methodologic Support: MEREVA, Bordeaux, France Website: http://www.mereva.net/iedea Funding Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development and the National Cancer Institute of the US National Institutes of Health under the following award numbers: Caribbean, Central, and South America: U01AI069923; Asia-Pacific: U01AI069907; Central Africa: U01A096299; East Africa: U01AI069911; Southern Africa: U01AI069924; West Africa: U01AI069919; NA-ACCORD: U01AI069918; and the IeDEA Network Coordinating Center: U01A1096186. NA-ACCORD contribution to this work was also supported by grants U01-DA036935, UL1-TR000083, K24-AI065298, K24-DA00432, KL2 TR000421, N02-CP55504, P30-AI27757, P30-AI27767, P30-AI036219, P30-AI50410, P30-AI54999, P30-AI094189, R01-AA16893, R01-DA11602 R24-AI067039; and the Government of Alberta, Canada. IeDEA Asia-Pacific received additional funding from the Dutch Ministry of Foreign Affairs through a partnership with Stichting AIDS Fonds, and from the Australian Government Department of Health and Ageing. REDCap support was provided through Vanderbilt University and UL1 TR000445 from NCATS/NIH.
© 2014 Duda SN et al; licensee International AIDS Society.
All Science Journal Classification (ASJC) codes
- Public Health, Environmental and Occupational Health
- Infectious Diseases