Comprehensiveness of HIV care provided at global HIV treatment sites in the IeDEA consortium: 2009 and 2014

Abstract

Introduction: An important determinant of the effectiveness of HIV treatment programs is the capacity of sites to implement recommended services and identify systematic changes needed to ensure that invested resources translate into improved patient outcomes. We conducted a survey in 2014 of HIV care and treatment sites in the seven regions of the International epidemiologic Database to Evaluate AIDS (IeDEA) Consortium to evaluate facility characteristics, HIV prevention, care and treatment services provided, laboratory capacity, and trends in the comprehensiveness of care compared to data obtained in the 2009 baseline survey. Methods: Clinical staff from 262 treatment sites in 45 countries in IeDEA completed a site survey from September 2014 to January 2015, including Asia-Pacific with Australia (n = 50), Latin America and the Caribbean (n = 11), North America (n = 45), Central Africa (n = 17), East Africa (n = 36), Southern Africa (n = 87), and West Africa (n = 16). For the 55 sites with complete data from both the 2009 and 2014 survey, we evaluated change in comprehensiveness of care. Results: The majority of the 262 sites (61%) offered seven essential services (ART adherence, nutritional support, PMTCT, CD4+ cell count testing, tuberculosis screening, HIV prevention, and outreach). Sites that were publicly funded (64%), cared for adults and children (68%), low or middle Human Development Index (HDI) rank (68%, 68%), and received PEPFAR support (71%) were most often fully comprehensive. CD4+ cell count testing was universally available (98%) but only 62% of clinics offered it onsite. Approximately two-thirds (69%) of sites reported routine viral load testing (44–100%), with 39% having it onsite. Laboratory capacity to monitor antiretroviral-related toxicity and diagnose opportunistic infections varied widely by testing modality and region. In the subgroup of 55 sites with two surveys, comprehensiveness of services provided significantly increased across all regions from 2009 to 2014 (5.7 to 6.5, p < 0.001). Conclusions: The availability of viral load monitoring remains suboptimal and should be a focus for site capacity, particularly in East and Southern Africa, where the majority of those initiating on ART reside. However, the comprehensiveness of care provided increased over the past 5 years and was related to type of funding received (publicly funded and PEPFAR supported).

Implementation of “Treat‐all” at adult HIV care and treatment sites in the Global IeDEA Consortium: results from the Site Assessment Survey

“…While almost all sites reported universal HIV treatment as the standard of care, we found considerable variation in site‐level practices related to rapid ART initiation, with private sector sites and sites in high‐resource settings more likely to report longer times to treatment initiation. Consistent with other research , we also found considerable variation in capacity for viral load monitoring, and almost one‐third of the sites implementing Treat All indicated that they could not routinely request or perform viral load testing. Such gaps were particularly prevalent among sites located in rural areas and in low‐income countries, as well as in countries where Treat All was adopted more recently.…”

“…IeDEA is a purely observational research consortium that does not dictate policies or practices to participating HIV care and treatment clinics. IeDEA regularly conducts general and specialized surveys in order to characterize the attributes, capacity and services available at sites that participate in the consortium .…”

Feasibility of antiretroviral therapy initiation under the treat‐all policy under routine conditions: a prospective cohort study from Eswatini

“…These interventions are implemented in different combinations and with varying quality across HIV programmes , and operationalization of Treat‐All may be challenging in weak health systems . Despite adoption of the Treat‐All policy by many countries , questions remain about the feasibility of ongoing ART expansion and provision of quality care in resource‐poor health settings , with many operational challenges anticipated .…”

Returning HIV‐1 viral load results to participant‐selected health facilities in national Population‐based HIV Impact Assessment (PHIA) household surveys in three sub‐Saharan African Countries, 2015 to 2016

“…Since the release of the 2013 WHO guidelines on the use of antiretrovirals, 47 out of 52 low and middle income countries have adopted routine VL monitoring for early detection of treatment failure in their national HIV policies . However, on‐site VL testing remains limited as documented in a recent study of 262 HIV care and treatment sites in 45 countries . The study found only 14% of 87 majority urban facilities in southern Africa had on‐site VL testing capabilities in 2014 .…”

“…However, on‐site VL testing remains limited as documented in a recent study of 262 HIV care and treatment sites in 45 countries . The study found only 14% of 87 majority urban facilities in southern Africa had on‐site VL testing capabilities in 2014 .…”