Open Access Research article

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

Daria N Podlekareva1*, Joanne Reekie2, Amanda Mocroft2, Marcelo Losso3, Aza G Rakhmanova4, Elzbieta Bakowska5, Igor A Karpov6, Jeffrey V Lazarus1, Jose Gatell7, Jens D Lundgren18, Ole Kirk18 and for the EuroSIDA study in EuroCoord

Author Affiliations

1 Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark

2 University College London Medical School, Royal Free Campus, London, UK

3 Hospital JM Ramos Mejia, Buenos Aires, Argentina

4 Botkin Hospital of Infectious Diseases, St Petersburg, Russia

5 Wojewodzki Szpital Zakazny, Warszawa, Poland

6 Belarus State Medical University, Minsk, Belarus

7 Hospital Clinic de Barcelona, Barcelona, Spain

8 Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark

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BMC Infectious Diseases 2012, 12:229  doi:10.1186/1471-2334-12-229

Published: 25 September 2012

Abstract

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/mm3 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.

Keywords:
HIV-infection; HIV health care; Health care interventions; Health care benchmark; HIV in Eastern Europe; HIV in Europe