Abstract
BackgroundThe massive scale-up of antiretroviral treatment (ART) access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. Optimising HIV care in countries with diverse medical systems is critical; however data on best practices for HIV healthcare delivery in resource-constrained settings are limited. This study aimed to understand patient characteristics and treatment outcomes from different HIV healthcare settings in Bangalore, India.MethodsParticipants from public, private and public-private HIV healthcare settings were recruited between 2007 and 2009 and were administered structured interviews by trained staff. Self-reported adherence was measured using the visual analogue scale to capture adherence over the past month, and a history of treatment interruptions (defined as having missed medications for more than 48 hours in the past three months). In addition, CD4 count and viral load (VL) were measured; genotyping for drug resistance-associated mutations was performed on those who were in virological failure (VL > 1000 copies/ml).ResultsA total of 471 individuals were included in the analysis (263 from the public facility, 149 from the public-private facility and 59 from the private center). Private facility patients were more likely to be male, with higher education levels and incomes. More participants reported ≥ 95% adherence among public and public-private groups compared to private participants (public 97%; private 88%; public-private 93%, p < 0.05). Treatment interruptions were lowest among public participants (1%, 10%, 5% respectively, p < 0.001). Although longer clinic waiting times were experienced by more public participants (48%, compared to private 27%, public-private 19%, p < 0.001), adherence barriers were highest among private (31%) compared with public (10%) and public-private (17%, p < 0.001) participants. Viral load was detectable in 13% public, 22% private and 9% public-private participants (p < 0.05) suggesting fewer treatment failures among public and public-private settings. Drug resistance mutations were found more frequently among private facility patients (20%) compared to those from the public (9%) or public-private facility (8%, p < 0.05).ConclusionsAdherence and treatment success was significantly higher among patients from public and public-private settings compared with patients from private facilities. These results suggest a possible benefit of the standardized care delivery system established in public and public-private health facilities where counselling by a multi-disciplinary team of workers is integral to provision of ART. Strengthening and increasing public-private partnerships can enhance the success of national ART programs.
Highlights
The massive scale-up of antiretroviral treatment (ART) access worldwide has brought tremendous benefit to populations affected by HIV/AIDS
The National AIDS Control Organization (NACO) program insists on multi-disciplinary care with comprehensive services provided by a physician, nurse, counsellor, and pharmacist within the same setting for each patient, with great emphasis placed on intense counselling sessions prior to initiation of ART and at each subsequent visit. (ii) The public-private facility was the ART Center at St
While the public facility had three-quarters of patients residing within the city and another 23% visiting from other parts of the state, the private and public-private facilities received a larger proportion of patients (19% and 18%, respectively, p < 0.001) from neighbouring states
Summary
The massive scale-up of antiretroviral treatment (ART) access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. The United Nations Secretary-General, Mr Kofi Annan, stated in 2001 that,“People no longer accept that the sick and dying, because they are poor, should be denied drugs which have transformed the lives of others who are better off” [2] It was with Kofi Annan’s lofty goal in mind that in 2004, the political leaders in India and the National AIDS Control Organization (NACO) initiated the National AIDS Control Program that provided free antiretroviral treatment access to all those in the nation who had a medical need for these drugs. Following a diagnosis of HIV infection and assessment of the need for medication, patients within these ART Centres are provided first-line ART free of cost along with intensive counselling at each visit Services in these centers are fully financed and delivered by the public sector in accordance with strict treatment guidelines set by the National Program [4]
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