Abstract
BackgroundState-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.MethodsFour indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART).Results7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively).ConclusionsThis assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.
Highlights
State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients
Our objectives were to evaluate the performance of four health care indicators (HCI), all based on current HIV treatment guidelines [1,2,3,4], and compare their utilisation across regions of Europe and Argentina in order to suggest a clinical benchmark for HIV health care
Patients from EE differed considerably from patients in other regions. They were younger, with a higher proportion of females; half of them were infected with HIV by injecting drug use (IDU) and were coinfected with HCV. 61% of patients in EE were combination antiretroviral therapy (cART)-naïve when recruited to the study
Summary
State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. State-of-the-art care of HIV patients requires the utilisation of multiple health care interventions, limited to laboratory and clinical. Several attempts have been made to develop HIV care quality measures which are typically limited to one country or a single clinic [7,8]. The World Health Organization (WHO) has developed a set of indicators for monitoring the health systems response to HIV/AIDS [9], which are mainly focused on health systems per se without the capability to monitor clinical management of patients (i.e. their immunological and virological status). The development of uniform measures for HIV care quality would allow cross-regional comparison and the identification of a benchmark for HIV care
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