title: Structure and quality of outpatient care for people living with an HIV infection.
abstract: Policy-makers and clinicians are faced with a gap of evidence to guide policy on standards for HIV outpatient care. Ongoing debates include which settings of care improve health outcomes, and how many HIV-infected patients a health-care provider should treat to gain and maintain expertise. In this article, we evaluate the studies that link health-care facility and care provider characteristics (i.e., structural factors) to health outcomes in HIV-infected patients. We searched the electronic databases MEDLINE, PUBMED, and EMBASE from inception until 1 January 2015. We included a total of 28 observational studies that were conducted after the introduction of combination antiretroviral therapy in 1996. Three aspects of the available research linking the structure to quality of HIV outpatient care were evaluated: (1) assessed structural characteristics (i.e., health-care facility and care provider characteristics); (2) measures of quality of HIV outpatient care; and (3) reported associations between structural characteristics and quality of care. Rather than scarcity of data, it is the diversity in methodology in the identified studies and the inconsistency of their results that led us to the conclusion that the scientific evidence is too weak to guide policy in HIV outpatient care. We provide recommendations on how to address this heterogeneity in future studies and offer specific suggestions for further reading that could be of interest for clinicians and researchers.
authors.affiliation: a Department of Internal Medicine, Division of Infectious Diseases , Academic Medical Center of the University of Amsterdam , Amsterdam , The Netherlands.|b Stichting HIV Monitoring , Amsterdam , The Netherlands.
authors.forename: Esther A N
authors.initials: EA
authors.lastname: Engelhard
authors.affiliation: b Stichting HIV Monitoring , Amsterdam , The Netherlands.
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.affiliation: c Department of Medical Psychology , Academic Medical Center of the University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Pythia T
authors.initials: PT
authors.lastname: Nieuwkerk
authors.affiliation: a Department of Internal Medicine, Division of Infectious Diseases , Academic Medical Center of the University of Amsterdam , Amsterdam , The Netherlands.|b Stichting HIV Monitoring , Amsterdam , The Netherlands.|d Department of Global Health and Amsterdam Institute for Global Health and Development , Academic Medical Center of the University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.affiliation: e Department of Infectious Diseases , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Kroon
authors.affiliation: f Onze Lieve Vrouwe Gasthuis, Internal Medicine , Amsterdam , The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Brinkman
authors.affiliation: a Department of Internal Medicine, Division of Infectious Diseases , Academic Medical Center of the University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000592:standards*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000592:standards*; D015658:HIV Infections / Q000628:therapy*; D006282:Health Personnel; D006801:Humans; D011787:Quality of Health Care; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; ambulatory care facilities; health personnel; quality of health care; treatment outcome