TY - JOUR

T1 - Benchmarking HIV health care

T2 - from individual patient care to health care evaluation. An example from the EuroSIDA study

AU - Podlekareva, Daria

AU - Reekie, Joanne

AU - Mocroft, Amanda

AU - Losso, Marcelo

AU - Rakhmanova, Aza G

AU - Bakowska, Elzbieta

AU - Karpov, Igor A

AU - Lazarus, Jeff

AU - Gatell, Jose

AU - Lundgren, Jens

AU - Kirk, Ole

PY - 2012/9

Y1 - 2012/9

N2 - ABSTRACT: BACKGROUND: 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. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four 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). RESULTS: 7097 EuroSIDA patients were included from North (n = 923), South (n = 1059), West-Central (n = 1290) East-Central (n = 1366), East (n = 1964) Europe, and Argentina (n = 495). Patients in East Europe with CD4 <200cells/muL 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 North, 89% vs. 84%, 78%, 78%, 61%, 55% in West-Central, South, East-Central, Argentina and East, respectively, p <0.0001. Compared to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East 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). CONCLUSIONS: The proposed assessment of HIV health care utilization document pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for assessment and benchmarking the clinical management of HIV-patients in any setting worldwide.

AB - ABSTRACT: BACKGROUND: 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. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four 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). RESULTS: 7097 EuroSIDA patients were included from North (n = 923), South (n = 1059), West-Central (n = 1290) East-Central (n = 1366), East (n = 1964) Europe, and Argentina (n = 495). Patients in East Europe with CD4 <200cells/muL 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 North, 89% vs. 84%, 78%, 78%, 61%, 55% in West-Central, South, East-Central, Argentina and East, respectively, p <0.0001. Compared to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East 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). CONCLUSIONS: The proposed assessment of HIV health care utilization document pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for assessment and benchmarking the clinical management of HIV-patients in any setting worldwide.

U2 - 10.1186/1471-2334-12-229

DO - 10.1186/1471-2334-12-229

M3 - Journal article

C2 - 23009317

VL - 12

SP - 229

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

SN - 1471-2334

ER -