title: Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration.
abstract: BACKGROUND
  HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide.
  
  
  METHODS
  Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services.
  
  
  RESULTS
  Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services.
  
  
  CONCLUSIONS
  This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.
authors.affiliation: Department of Biomedical Informatics, Vanderbilt School of Medicine, Nashville, TN, USA; stephany.duda@vanderbilt.edu.
authors.forename: Stephany N
authors.initials: SN
authors.lastname: Duda
authors.affiliation: Department of Life Sciences, Truven Health Analytics, Cambridge, MA, USA; School of Public Health, City University of New York, New York, NY, USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Farr
authors.affiliation: Department of Pediatrics, Vanderbilt School of Medicine, Nashville, TN, USA; Department of Health Policy, Vanderbilt School of Medicine, Nashville, TN, USA.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Lindegren
authors.affiliation: Department of Biostatistics, Vanderbilt School of Medicine, Nashville, TN, USA; Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.affiliation: Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA; Department of Medicine, Division of Infectious Diseases, Vanderbilt School of Medicine, Nashville, TN, USA.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloustian
authors.affiliation: Université de Bordeaux, ISPED, centre Inserm U897 Épidémiologie-Biostatistique, 33000, Bordeaux, France; Programme PAC-CI, Site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire; Université de Lomé, Faculté des Sciences de la Santé, Départment de Santé Publique, Lomé, Togo.
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.affiliation: Research Triangle Institute, Raleigh, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway-Foday
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt School of Medicine, Nashville, TN, USA.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.affiliation: Epidemiology and Biostatistics Program, Hunter College, City University of New York, New York, NY, USA; Doctor of Public Health Programs (CUNY SPH), School of Public Health, City University of New York, New York, NY, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D000569:Americas; D044362:Australasia; D002648:Child; D002675:Child, Preschool; D003191:Comprehensive Health Care; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006302:Health Services Research; D006801:Humans; D008297:Male
keywords: HIV care capacity; HIV/AIDS; clinic characteristics; comprehensive care; resource-limited settings