title: Characteristics of HIV care and treatment in PEPFAR-supported sites.
abstract: BACKGROUND
  The US President's Emergency Plan for AIDS Relief (PEPFAR) has supported the extension of HIV care and treatment to 2.4 million individuals as of September 2009. With increasing resources targeted toward rapid scale-up, it is important to understand the characteristics of current PEPFAR-supported HIV care and treatment sites.
  
  
  METHODS
  Forty-five sites in Botswana, Ethiopia, Nigeria, Uganda, and Vietnam were sampled. Data were collected retrospectively from successive 6-month periods through reviews of facility records and interviews with site personnel between April 2006 and March 2007. Facility size and scale-up rate, patient characteristics, staffing models, clinical and laboratory monitoring, and intervention mix were compared.
  
  
  RESULTS
  Sites added a median of 293 patients per quarter. By the evaluation's end, sites supported a median of 1649 HIV patients, 922 of them receiving antiretroviral therapy. Patients were predominantly adult (97.4%), and the majority (96.5%) were receiving regimens based on nonnucleoside reverse transcriptase inhibitors. The ratios of physicians to patients dropped substantially as sites matured. Antiretroviral therapy patients were commonly seen monthly or quarterly for clinical and laboratory monitoring, with CD4 counts being taken at 6-month intervals. One-third of sites provided viral load testing. Cotrimoxazole prophylaxis was the most prevalent supportive service.
  
  
  CONCLUSIONS
  HIV treatment sites scaled up rapidly with the influx of resources and technical support through PEPFAR, providing complex health services to progressively expanding patient cohorts. Human resources are stretched thin, and delivery models and intervention mix differ widely between sites. Ongoing research is needed to identify best-practice service delivery models.
authors.affiliation: US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA 30341, USA. SFiller@cdc.gov
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Filler
authors.forename: Andres A
authors.initials: AA
authors.lastname: Berruti
authors.forename: Nick
authors.initials: N
authors.lastname: Menzies
authors.forename: Rick
authors.initials: R
authors.lastname: Berzon
authors.forename: Tedd V
authors.initials: TV
authors.lastname: Ellerbrock
authors.forename: Robert
authors.initials: R
authors.lastname: Ferris
authors.forename: John M
authors.initials: JM
authors.lastname: Blandford
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007391:International Cooperation; D008297:Male; D012189:Retrospective Studies; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents