Fritz Cristin Q, Blevins Meridith, Lindegren Mary Lou, Wools-Kaloutsian Kara, Musick Beverly S, Cornell Morna, Goodwin Kelly, Addison Dianne, Dusingize Jean Claude, Messou Eugène, Poda Armel, Duda Stephany N, McGowan Catherine C, Law Matthew G, Moore Richard D, Freeman Aimee, Nash Denis, Wester C William
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
J Int AIDS Soc. 2017 Jan 6;20(1):20933. doi: 10.7448/IAS.20.1.20933.
An important determinant of the effectiveness of HIV treatment programs is the capacity of sites to implement recommended services and identify systematic changes needed to ensure that invested resources translate into improved patient outcomes. We conducted a survey in 2014 of HIV care and treatment sites in the seven regions of the International epidemiologic Database to Evaluate AIDS (IeDEA) Consortium to evaluate facility characteristics, HIV prevention, care and treatment services provided, laboratory capacity, and trends in the comprehensiveness of care compared to data obtained in the 2009 baseline survey.
Clinical staff from 262 treatment sites in 45 countries in IeDEA completed a site survey from September 2014 to January 2015, including Asia-Pacific with Australia ( = 50), Latin America and the Caribbean ( = 11), North America ( = 45), Central Africa ( = 17), East Africa ( = 36), Southern Africa ( = 87), and West Africa ( = 16). For the 55 sites with complete data from both the 2009 and 2014 survey, we evaluated change in comprehensiveness of care.
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%), cared for 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 clinics offered it onsite. Approximately two-thirds (69%) of sites reported routine viral load testing (44-100%), with 39% having it onsite. Laboratory capacity to monitor antiretroviral-related toxicity and diagnose opportunistic infections varied widely by testing modality and region. In the subgroup of 55 sites with two surveys, comprehensiveness of services provided significantly increased across all regions from 2009 to 2014 (5.7 to 6.5, < 0.001).
The availability of viral load monitoring remains suboptimal and should be a focus for site capacity, particularly in East and Southern Africa, where the majority of those initiating on ART reside. However, the comprehensiveness of care provided increased over the past 5 years and was related to type of funding received (publicly funded and PEPFAR supported).
艾滋病毒治疗项目有效性的一个重要决定因素是各机构实施推荐服务的能力，以及确定为确保投入的资源转化为改善患者治疗效果所需的系统性变革。2014年，我们对国际流行病学数据库评估艾滋病（IeDEA）联盟七个地区的艾滋病毒护理和治疗机构进行了一项调查，以评估机构特征、所提供的艾滋病毒预防、护理和治疗服务、实验室能力，以及与2009年基线调查数据相比护理全面性的趋势。
IeDEA中45个国家262个治疗机构的临床工作人员于2014年9月至2015年1月完成了一项机构调查，这些地区包括亚太地区及澳大利亚（n = 50）、拉丁美洲和加勒比地区（n = 11）、北美洲（n = 45）、中非（n = 17）、东非（n = 36）、南非（n = 87）和西非（n = 16）。对于2009年和2014年调查均有完整数据的55个机构，我们评估了护理全面性的变化。
262个机构中的大多数（61%）提供了七项基本服务（抗逆转录病毒治疗依从性、营养支持、预防母婴传播、CD4 + 细胞计数检测、结核病筛查、艾滋病毒预防和外展服务）。由公共资金资助的机构（64%）、为成人和儿童提供护理的机构（68%）、人类发展指数（HDI）排名低或中等的机构（68%，68%）以及接受总统艾滋病紧急救援计划（PEPFAR）支持的机构（71%）最常提供全面服务。CD4 + 细胞计数检测普遍可用（98%），但只有62%的诊所可在现场进行检测。约三分之二（69%）的机构报告了常规病毒载量检测（44 - 100%），其中39%可在现场进行检测。监测抗逆转录病毒相关毒性和诊断机会性感染的实验室能力因检测方式和地区而异。在有两次调查数据的55个机构子集中，从2009年到2014年，所有地区提供的服务全面性均显著提高（5.7至6.5，P < 0.001）。
病毒载量监测的可用性仍然不理想，应成为机构能力建设的重点，特别是在大多数开始接受抗逆转录病毒治疗的患者所在的东非和南非。然而，在过去5年中，所提供护理的全面性有所提高，且与所获得的资金类型（公共资金资助和PEPFAR支持）有关。
