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.