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

the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

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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.

Original languageEnglish
Article number19045
JournalJournal of the International AIDS Society
Volume17
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

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Africa South of the Sahara
Acquired Immunodeficiency Syndrome
HIV
Databases
Human Development
Therapeutics
Tuberculosis
Community-Institutional Relations
Contact Tracing
Central Africa
Southern Africa
Eastern Africa
Western Africa
Nutritional Support
Latin America
United Nations
Social Welfare
Quality of Health Care
Isoniazid
CD4 Lymphocyte Count

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

@article{e7a9001f2a0e4ccea87206b90a469e7a,
title = "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",
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.",
author = "{the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration} and Duda, {Stephany N.} and Farr, {Amanda M.} and Lindegren, {Mary Lou} and Meridith Blevins and Wester, {C. William} and Kara Wools-Kaloustian and Ekouevi, {Didier K.} and Matthias Egger and Jennifer Hemingway-Foday and Cooper, {David A.} and Moore, {Richard D.} and McGowan, {Catherine C.} and Denis Nash and Vonthanak Saphonn and Sarun Saramony and Ning Han and Lee, {Man Po} and Fujie Zhang and Vivek Bele and Sanjay Pujari and Tuti Merati and Okki Ramadian and Flora Yuliana and Evy Yunihastuti and Shinichi Oka and Misao Takano and Anna Kajindran and Adeeba Kamarulzaman and Low, {Lee Lee} and Sim, {Benedict L.H.} and Rowena Capistrano and Rossana Ditangco and Kuo, {Lou Hui} and Wong, {Wing Wai} and Romanee Chaiwarith and Mana Khongpattanayothin and Sasisopin Kiertiburanakul and Wilai Kotarathititum and Praphan Phanuphak and Bucha Piyavong and Estelle Fou and Ng, {Oon Tek} and JunYong Choi and Han, {Sang Hoon} and Andrew Carr and John Chuah and Bridget Dickson and Jennifer Hoy and Jing Ji and Richard Norris",
year = "2014",
month = "1",
day = "1",
doi = "10.7448/IAS.17.1.19045",
language = "English",
volume = "17",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",
number = "1",

}

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, JunYong

AU - Han, Sang Hoon

AU - Carr, Andrew

AU - Chuah, John

AU - Dickson, Bridget

AU - Hoy, Jennifer

AU - Ji, Jing

AU - Norris, Richard

PY - 2014/1/1

Y1 - 2014/1/1

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.

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U2 - 10.7448/IAS.17.1.19045

DO - 10.7448/IAS.17.1.19045

M3 - Article

VL - 17

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

IS - 1

M1 - 19045

ER -