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

Stephany N. Duda*, Amanda M. Farr, Mary Lou Lindegren, Meridith Blevins, C. William Wester, Kara Wools-Kaloustian, Didier K. Ekouevi, Matthias Egger, Jennifer Hemingway-Foday, David A. Cooper, Richard D. Moore, Catherine C. McGowan, Denis Nash, Vonthanak Saphonn, Sarun Saramony, Ning Han, Man Po Lee, Fujie Zhang, Vivek Bele, Sanjay Pujari & 31 others Tuti Merati, Okki Ramadian, Flora Yuliana, Evy Yunihastuti, Shinichi Oka, Misao Takano, Anna Kajindran, Adeeba Kamarulzaman, Lee Lee Low, Benedict L H Sim, Rowena Capistrano, Rossana Ditangco, Lou Hui Kuo, Wing Wai Wong, Romanee Chaiwarith, Mana Khongpattanayothin, Sasisopin Kiertiburanakul, Wilai Kotarathititum, Praphan Phanuphak, Bucha Piyavong, Estelle Fou, Oon Tek Ng, Jun Yong Choi, Sang Hoon Han, Andrew Carr, John Chuah, Bridget Dickson, Jennifer Hoy, Jing Ji, Firas Wehbe, the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

*Corresponding author for this work

Research output: Contribution to journalArticle

25 Citations (Scopus)

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 (US)
Article number19045
JournalJournal of the International AIDS Society
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2014

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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

Keywords

  • Clinic characteristics
  • Comprehensive care
  • HIV care capacity
  • HIV/AIDS
  • Resource-limited settings

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Duda, Stephany N. ; Farr, Amanda M. ; Lindegren, Mary Lou ; Blevins, Meridith ; Wester, C. William ; Wools-Kaloustian, Kara ; Ekouevi, Didier K. ; Egger, Matthias ; Hemingway-Foday, Jennifer ; Cooper, David A. ; Moore, Richard D. ; McGowan, Catherine C. ; Nash, Denis ; Saphonn, Vonthanak ; Saramony, Sarun ; Han, Ning ; Lee, Man Po ; Zhang, Fujie ; Bele, Vivek ; Pujari, Sanjay ; Merati, Tuti ; Ramadian, Okki ; Yuliana, Flora ; Yunihastuti, Evy ; Oka, Shinichi ; Takano, Misao ; Kajindran, Anna ; Kamarulzaman, Adeeba ; Low, Lee Lee ; Sim, Benedict L H ; Capistrano, Rowena ; Ditangco, Rossana ; Kuo, Lou Hui ; Wong, Wing Wai ; Chaiwarith, Romanee ; Khongpattanayothin, Mana ; Kiertiburanakul, Sasisopin ; Kotarathititum, Wilai ; Phanuphak, Praphan ; Piyavong, Bucha ; Fou, Estelle ; Ng, Oon Tek ; Choi, Jun Yong ; Han, Sang Hoon ; Carr, Andrew ; Chuah, John ; Dickson, Bridget ; Hoy, Jennifer ; Ji, Jing ; Wehbe, Firas ; the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration. / 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. In: Journal of the International AIDS Society. 2014 ; Vol. 17, No. 1.
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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.",
keywords = "Clinic characteristics, Comprehensive care, HIV care capacity, HIV/AIDS, Resource-limited settings",
author = "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 Choi, {Jun Yong} and Han, {Sang Hoon} and Andrew Carr and John Chuah and Bridget Dickson and Jennifer Hoy and Jing Ji and Firas Wehbe and {the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration}",
year = "2014",
month = "1",
day = "1",
doi = "10.7448/IAS.17.1.19045",
language = "English (US)",
volume = "17",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",
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Duda, SN, Farr, AM, Lindegren, ML, Blevins, M, Wester, CW, Wools-Kaloustian, K, Ekouevi, DK, Egger, M, Hemingway-Foday, J, Cooper, DA, Moore, RD, McGowan, CC, Nash, D, 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, BLH, 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, Wehbe, F & the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration 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', Journal of the International AIDS Society, vol. 17, no. 1, 19045. https://doi.org/10.7448/IAS.17.1.19045

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. / Duda, Stephany N.; Farr, Amanda M.; Lindegren, Mary Lou; Blevins, Meridith; Wester, C. William; Wools-Kaloustian, Kara; Ekouevi, Didier K.; Egger, Matthias; Hemingway-Foday, Jennifer; Cooper, David A.; Moore, Richard D.; McGowan, Catherine C.; Nash, Denis; Saphonn, Vonthanak; Saramony, Sarun; Han, Ning; Lee, Man Po; Zhang, Fujie; Bele, Vivek; Pujari, Sanjay; Merati, Tuti; Ramadian, Okki; Yuliana, Flora; Yunihastuti, Evy; Oka, Shinichi; Takano, Misao; Kajindran, Anna; Kamarulzaman, Adeeba; Low, Lee Lee; Sim, Benedict L H; Capistrano, Rowena; Ditangco, Rossana; Kuo, Lou Hui; Wong, Wing Wai; Chaiwarith, Romanee; Khongpattanayothin, Mana; Kiertiburanakul, Sasisopin; Kotarathititum, Wilai; Phanuphak, Praphan; Piyavong, Bucha; Fou, Estelle; Ng, Oon Tek; Choi, Jun Yong; Han, Sang Hoon; Carr, Andrew; Chuah, John; Dickson, Bridget; Hoy, Jennifer; Ji, Jing; Wehbe, Firas; the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration.

In: Journal of the International AIDS Society, Vol. 17, No. 1, 19045, 01.01.2014.

Research output: Contribution to journalArticle

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 - 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 - Wehbe, Firas

AU - the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

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.

KW - Clinic characteristics

KW - Comprehensive care

KW - HIV care capacity

KW - HIV/AIDS

KW - Resource-limited settings

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DO - 10.7448/IAS.17.1.19045

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JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

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ER -