title: Impact of HIV care facility characteristics on the cascade of care in HIV-infected patients in the Netherlands.
abstract: OBJECTIVE
  Successful treatment of people infected with HIV requires that patients are retained in HIV care, use combination antiretroviral therapy (cART) and ultimately reach and sustain viral suppression. Our aim was to identify health facility characteristics associated with these steps in the cascade of HIV care.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  We included data from all adult HIV-1-infected patients who entered care in the Netherlands between 2007 and 2013 (N = 7120). Multivariate logistic regression was used to examine the associations between health facility characteristics and the outcomes 'currently in care', 'initiated cART', and 'viral suppression'.
  
  
  RESULTS
  The proportion of patients 'currently in care' was high in all 26 treatment centres. cART initiation was positively associated with the accreditation of the health facility [OR (odds ratio): 1.62; 95% CI (confidence interval): 1.18-2.23] and the performance of an internal audit in the preceding 3 years (OR: 1.36; 95% CI: 1.02-1.81). The odds of cART initiation were higher in middle-sized (OR: 2.00; 95% CI: 1.25-3.21) and large HIV treatment centres (OR: 1.80; 95% CI: 1.14-2.84) compared with small centres (<300 HIV-infected patients). Viral suppression was negatively associated with the presence of a social worker in the HIV treatment team (OR: 0.62; 95% CI: 0.43-0.91).
  
  
  CONCLUSIONS
  Our results confirm that appointing expert HIV treatment centres facilitates retention in care and that a minimum volume requirement may be desirable. Our findings suggest that quality assessment through accreditation and the measurement of performance benefits the delivery of HIV care.
authors.affiliation: aDivision of Infectious Diseases, Academic Medical Center of the University of AmsterdambStichting HIV Monitoring, AmsterdamcDepartment of Global Health, Academic Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and DevelopmentdDepartment of Medical Psychology, Academic Medical Center of the University of Amsterdam, AmsterdameDepartment of Infectious Diseases, Leiden University Medical Center, LeidenfDepartment of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Esther A N
authors.initials: EA
authors.lastname: Engelhard
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.forename: Ard
authors.initials: A
authors.lastname: Van Sighem
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Pythia T
authors.initials: PT
authors.lastname: Nieuwkerk
authors.forename: Frank P
authors.initials: FP
authors.lastname: Kroon
authors.forename: Kees
authors.initials: K
authors.lastname: Brinkman
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult