Impact of HIV Care Facility Characteristics on the Cascade of Care in HIV-Infected Patients in The Netherlands
OBJECTIVE:
Successful
treatment of people infected with HIV requires that patients are retained in
HIV care, use combination antiretroviral therapy (cART) and ultimately reach
and sustain viral suppression. Our aim was to identify health facility
characteristics associated with these steps in the cascade of HIV care.
METHODS:
We
included data from all adult HIV-1-infected patients who entered care in the
Netherlands between 2007 and 2013 (N = 7120). Multivariate logistic regression
was used to examine the associations between health facility characteristics
and the outcomes 'currently in care', 'initiated cART', and 'viral suppression'.
RESULTS:
The
proportion of patients 'currently in care' was high in all 26 treatment
centres. cART initiation was positively associated with the accreditation of
the health facility [OR (odds ratio): 1.62; 95% CI (confidence interval):
1.18-2.23] and the performance of an internal audit in the preceding 3 years
(OR: 1.36; 95% CI: 1.02-1.81). The odds of cART initiation were higher in
middle-sized (OR: 2.00; 95% CI: 1.25-3.21) and large HIV treatment centres (OR:
1.80; 95% CI: 1.14-2.84) compared with small centres (<300 HIV-infected
patients). Viral suppression was negatively associated with the presence of a
social worker in the HIV treatment team (OR: 0.62; 95% CI: 0.43-0.91).
CONCLUSIONS:
Our
results confirm that appointing expert HIV treatment centres facilitates
retention in care and that a minimum volume requirement may be desirable. Our
findings suggest that quality assessment through accreditation and the
measurement of performance benefits the delivery of HIV care.
- 1aDivision of Infectious Diseases, Academic Medical Center of the University of Amsterdam bStichting HIV Monitoring, AmsterdamcDepartment of Global Health, Academic Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and Development d Department of Medical Psychology, Academic Medical Center of the University of Amsterdam, Amsterdam e Department of Infectious Diseases, Leiden University Medical Center, Leidenf Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
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