Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

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: Co...

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Published in:	BMC infectious diseases Vol. 12; no. 1; p. 229
Main Authors:	Podlekareva, Daria N, Reekie, Joanne, Mocroft, Amanda, Losso, Marcelo, Rakhmanova, Aza G, Bakowska, Elzbieta, Karpov, Igor A, Lazarus, Jeffrey V, Gatell, Jose, Lundgren, Jens D, Kirk, Ole
Format:	Journal Article
Language:	English
Published:	London BioMed Central 25.09.2012 BioMed Central Ltd Springer Nature B.V BMC
Subjects:	Acquired immune deficiency syndrome Adult AIDS Antiretroviral agents Antiviral agents Argentina Argentina - epidemiology Austria Belarus Belgium Benchmarking Benchmarks Care and treatment Chemoprevention - methods College campuses Colleges & universities Croatia Czech Republic Denmark Drug Monitoring - methods Estonia Europe - epidemiology Female Finland France Germany Greece Guideline Adherence - statistics & numerical data Health care Health care benchmark Health care interventions Health Services Research Highly active antiretroviral therapy HIV HIV (Viruses) HIV and co-infections HIV health care HIV in Eastern Europe HIV in Europe HIV infection HIV Infections - diagnosis HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - prevention & control HIV patients Hospitals Human immunodeficiency virus Humans Hungary Infectious Diseases Internal Medicine Ireland Israel Latvia Lithuania Luxembourg Male Medical care Medical Microbiology Medicine Medicine & Public Health Middle Aged Netherlands Norway Parasitology Patient Care - methods Patients Poland Portugal Research Article RNA RNA, Viral - blood Russia Serbia Slovakia Spain Sweden Tropical Medicine Ukraine United Kingdom Viral Load Argentina Europe Portugal Russia Greece Latvia Austria Netherlands Sweden Luxembourg Ireland Poland Slovakia France Lithuania Serbia Croatia Hungary Ukraine United Kingdom Belarus Spain Czech Republic Belgium Norway Finland Denmark Israel Germany Estonia Health care benchmark Health care interventions HIV in Eastern Europe HIV in Europe HIV health care HIV-infection
ISSN:	1471-2334, 1471-2334
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Summary:	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.
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ISSN:	1471-2334 1471-2334
DOI:	10.1186/1471-2334-12-229