title: Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study.
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 Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm(3) 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 Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe 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
  This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark. dpo@cphiv.dk
authors.forename: Daria N
authors.initials: DN
authors.lastname: Podlekareva
authors.forename: Joanne
authors.initials: J
authors.lastname: Reekie
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Marcelo
authors.initials: M
authors.lastname: Losso
authors.forename: Aza G
authors.initials: AG
authors.lastname: Rakhmanova
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Bakowska
authors.forename: Igor A
authors.initials: IA
authors.lastname: Karpov
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Lazarus
authors.forename: Jose
authors.initials: J
authors.lastname: Gatell
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
mesh_terms: D000328:Adult; D001118:Argentina / Q000453:epidemiology; D019985:Benchmarking; D018890:Chemoprevention / Q000379:methods; D016903:Drug Monitoring / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
chemical_list: D012367:RNA, Viral