Comprehensiveness of HIV care provided at global HIVtreatment sites in the IeDEA consortium: 2009 and2014

Abstract

Introduction:An important determinant of the effectiveness of HIV treatment programs is the capacity of sites to implementrecommended services and identify systematic changes needed to ensure that invested resources translate into improvedpatient outcomes. We conducted a survey in 2014 of HIV care and treatment sites in the seven regions of the Internationalepidemiologic Database to Evaluate AIDS (IeDEA) Consortium to evaluate facility characteristics, HIV prevention, care andtreatment services provided, laboratory capacity, and trends in the comprehensiveness of care compared to data obtained inthe 2009 baseline survey.Methods:Clinical staff from 262 treatment sites in 45 countries in IeDEA completed a site survey from September 2014 toJanuary 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 completedata 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%), caredfor 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 clinicsoffered it onsite. Approximately two-thirds (69%) of sites reported routine viral load testing (44–100%), with 39% having itonsite. Laboratory capacity to monitor antiretroviral-related toxicity and diagnose opportunistic infections varied widely bytesting modality and region. In the subgroup of 55 sites with two surveys, comprehensiveness of services providedsignificantly 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 inEast and Southern Africa, where the majority of those initiating on ART reside. However, the comprehensiveness of care providedincreased over the past 5 years and was related to type of funding received (publicly funded and PEPFAR supported).