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 PujariTuti 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 journalArticlepeer-review

34 Scopus citations


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
Issue number1
StatePublished - 2014


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

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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