title: Comprehensiveness of HIV care provided at global HIV treatment sites in the IeDEA consortium: 2009 and 2014.
abstract: An important determinant of the effectiveness of HIV treatment programs is the capacity of sites to implement recommended services and identify systematic changes needed to ensure that invested resources translate into improved patient outcomes. We conducted a survey in 2014 of HIV care and treatment sites in the seven regions of the International epidemiologic Database to Evaluate AIDS (IeDEA) Consortium to evaluate facility characteristics, HIV prevention, care and treatment services provided, laboratory capacity, and trends in the comprehensiveness of care compared to data obtained in the 2009 baseline survey.
  
  
  
  Clinical staff from 262 treatment sites in 45 countries in IeDEA completed a site survey from September 2014 to January 2015, including Asia-Pacific with Australia (n= 50), Latin America and the Caribbean (n= 11), North America (n= 45), Central Africa (n= 17), East Africa (n= 36), Southern Africa (n= 87), and West Africa (n= 16). For the 55 sites with complete data from both the 2009 and 2014 survey, we evaluated change in comprehensiveness of care.
  
  
  
  The majority of the 262 sites (61%) offered seven essential services (ART adherence, nutritional support, PMTCT, CD4+ cell count testing, tuberculosis screening, HIV prevention, and outreach). Sites that were publicly funded (64%), cared for adults and children (68%), low or middle Human Development Index (HDI) rank (68%, 68%), and received PEPFAR support (71%) were most often fully comprehensive. CD4+ cell count testing was universally available (98%) but only 62% of clinics offered it onsite. Approximately two-thirds (69%) of sites reported routine viral load testing (44-100%), with 39% having it onsite. Laboratory capacity to monitor antiretroviral-related toxicity and diagnose opportunistic infections varied widely by testing modality and region. In the subgroup of 55 sites with two surveys, comprehensiveness of services provided significantly increased across all regions from 2009 to 2014 (5.7 to 6.5,p< 0.001).
  
  
  
  The availability of viral load monitoring remains suboptimal and should be a focus for site capacity, particularly in East and Southern Africa, where the majority of those initiating on ART reside. However, the comprehensiveness of care provided increased over the past 5 years and was related to type of funding received (publicly funded and PEPFAR supported).
authors.affiliation: Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Cristin Q
authors.initials: CQ
authors.lastname: Fritz
authors.affiliation: Department of Biostatistics, Vanderbilt University 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: Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.|Department of Health Policy, Vanderbilt University School of Medicine.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Lindegren
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloutsian
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Beverly S
authors.initials: BS
authors.lastname: Musick
authors.affiliation: Centre for Infectious Disease Epidemiology & Research & Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Morna
authors.initials: M
authors.lastname: Cornell
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Kelly
authors.initials: K
authors.lastname: Goodwin
authors.affiliation: Department of Epidemiology and Biostatistics, City University of New York, School of Public Health, New York, NY, USA.
authors.forename: Dianne
authors.initials: D
authors.lastname: Addison
authors.affiliation: Rwanda Military Hospital, Kigali, Rwanda.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Dusingize
authors.affiliation: Centre de Prise en charge de Recherche et de Formation, Hôpital Yopougon Attié, Abidjan, Côte d'Ivoire.
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.affiliation: Institut Supérieur des Sciences de la santé, Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
authors.forename: Armel
authors.initials: A
authors.lastname: Poda
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Stephany N
authors.initials: SN
authors.lastname: Duda
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.affiliation: Kirby Institute, UNSW Australia, Sydney, Australia.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Aimee
authors.initials: A
authors.lastname: Freeman
authors.affiliation: Department of Epidemiology and Biostatistics, City University of New York, School of Public Health, New York, NY, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.affiliation: Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.|Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001208:Asia; D001315:Australia; D018791:CD4 Lymphocyte Count; D002648:Child; D015331:Cohort Studies; D005260:Female; D005376:Financial Management; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; HIV care capacity; comprehensive care; implementation science; laboratory capacity; resource-limited settings; survey