1 CHIP, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, Københavns Universitet2 Department of Immunology and Microbiology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, Københavns Universitet3 unknown4 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet5 CHIP, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, Københavns Universitet6 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
from individual patient care to health care evaluation. An example from the EuroSIDA study
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 North (n = 923), South (n = 1059), West-Central (n = 1290) East-Central (n = 1366), East (n = 1964) Europe, and Argentina (n = 495). Patients in East Europe with CD4 <200cells/muL 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 North, 89% vs. 84%, 78%, 78%, 61%, 55% in West-Central, South, East-Central, Argentina and East, respectively, p <0.0001. Compared to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East 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: The proposed assessment of HIV health care utilization document pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for assessment and benchmarking the clinical management of HIV-patients in any setting worldwide.