Department of Pediatrics, St John's National Academy of Health Sciences, Bangalore, India.
BMC Health Serv Res. 2011 Oct 17;11:277. doi: 10.1186/1472-6963-11-277.
The 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.
Participants 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).
A 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).
Adherence 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.
全球范围内抗逆转录病毒治疗（ART）的大规模推广为受艾滋病毒/艾滋病影响的人群带来了巨大的利益。优化医疗体系多样化的国家的艾滋病毒护理至关重要；然而，资源有限环境下艾滋病毒医疗保健提供的最佳实践的数据有限。本研究旨在了解班加罗尔不同艾滋病毒保健环境中的患者特征和治疗结果。
2007 年至 2009 年间，在公共、私人和公私混合的艾滋病毒保健机构招募参与者，并由经过培训的工作人员对其进行结构化访谈。使用视觉模拟量表测量自我报告的依从性，以捕捉过去一个月的依从性，以及过去三个月中因错过药物治疗超过 48 小时而中断治疗的情况（定义为中断治疗）。此外，还测量了 CD4 计数和病毒载量（VL）；对那些病毒学失败（VL > 1000 拷贝/ml）的人进行耐药相关突变的基因分型。
共有 471 人纳入分析（公共设施 263 人，公私混合设施 149 人，私人中心 59 人）。私立机构的患者更有可能是男性，具有更高的教育水平和收入。与私人参与者相比，报告≥95%依从性的参与者更多（公共设施 97%；私人设施 88%；公私混合设施 93%，p<0.05）。中断治疗的情况在公共参与者中最低（分别为 1%、10%和 5%，p<0.001）。虽然更多的公共参与者经历了更长的诊所等待时间（48%，而私人参与者为 27%，公私混合参与者为 19%，p<0.001），但私人参与者（31%）的依从性障碍最高，而公共参与者（10%）和公私混合参与者（17%）的依从性障碍较低（p<0.001）。在公共、私人和公私混合参与者中，分别有 13%、22%和 9%的人可检测到病毒载量（p<0.05），表明公共和公私混合设施的治疗失败较少。与来自公共（9%）或公私混合（8%）设施的患者相比，来自私人设施的患者发现耐药性突变更为常见（20%）（p<0.05）。
与来自私人机构的患者相比，来自公共和公私混合机构的患者的依从性和治疗成功率显著更高。这些结果表明，在公共和公私混合卫生机构中建立的标准化护理提供系统可能具有一定的益处，在这些机构中，多学科团队的咨询是提供抗逆转录病毒治疗的重要组成部分。加强和增加公私伙伴关系可以提高国家抗逆转录病毒治疗方案的成功率。
