High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems
<p>Abstract</p> <p>Background</p> <p>The massive scale-up of antiretroviral treatment (ART) access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. Optimising HIV care in countries with diverse medical systems is critical; however data on be...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2011-10-01
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| Series: | BMC Health Services Research |
| Online Access: | http://www.biomedcentral.com/1472-6963/11/277 |
| _version_ | 1818362284190203904 |
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| author | Heylen Elsa DeCosta Ayesha Shet Anita Shastri Suresh Chandy Sara Ekstrand Maria |
| author_facet | Heylen Elsa DeCosta Ayesha Shet Anita Shastri Suresh Chandy Sara Ekstrand Maria |
| author_sort | Heylen Elsa |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>The massive scale-up of antiretroviral treatment (ART) access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. Optimising HIV care in countries with diverse medical systems is critical; however data on best practices for HIV healthcare delivery in resource-constrained settings are limited. This study aimed to understand patient characteristics and treatment outcomes from different HIV healthcare settings in Bangalore, India.</p> <p>Methods</p> <p>Participants from public, private and public-private HIV healthcare settings were recruited between 2007 and 2009 and were administered structured interviews by trained staff. Self-reported adherence was measured using the visual analogue scale to capture adherence over the past month, and a history of treatment interruptions (defined as having missed medications for more than 48 hours in the past three months). In addition, CD4 count and viral load (VL) were measured; genotyping for drug resistance-associated mutations was performed on those who were in virological failure (VL > 1000 copies/ml).</p> <p>Results</p> <p>A total of 471 individuals were included in the analysis (263 from the public facility, 149 from the public-private facility and 59 from the private center). Private facility patients were more likely to be male, with higher education levels and incomes. More participants reported ≥ 95% adherence among public and public-private groups compared to private participants (public 97%; private 88%; public-private 93%, p < 0.05). Treatment interruptions were lowest among public participants (1%, 10%, 5% respectively, p < 0.001). Although longer clinic waiting times were experienced by more public participants (48%, compared to private 27%, public-private 19%, p < 0.001), adherence barriers were highest among private (31%) compared with public (10%) and public-private (17%, p < 0.001) participants. Viral load was detectable in 13% public, 22% private and 9% public-private participants (p < 0.05) suggesting fewer treatment failures among public and public-private settings. Drug resistance mutations were found more frequently among private facility patients (20%) compared to those from the public (9%) or public-private facility (8%, p < 0.05).</p> <p>Conclusions</p> <p>Adherence and treatment success was significantly higher among patients from public and public-private settings compared with patients from private facilities. These results suggest a possible benefit of the standardized care delivery system established in public and public-private health facilities where counselling by a multi-disciplinary team of workers is integral to provision of ART. Strengthening and increasing public-private partnerships can enhance the success of national ART programs.</p> |
| first_indexed | 2024-12-13T21:30:08Z |
| format | Article |
| id | doaj.art-a88bf7e562564eaea024f66561dc3f87 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-13T21:30:08Z |
| publishDate | 2011-10-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj.art-a88bf7e562564eaea024f66561dc3f872022-12-21T23:30:50ZengBMCBMC Health Services Research1472-69632011-10-0111127710.1186/1472-6963-11-277High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systemsHeylen ElsaDeCosta AyeshaShet AnitaShastri SureshChandy SaraEkstrand Maria<p>Abstract</p> <p>Background</p> <p>The massive scale-up of antiretroviral treatment (ART) access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. Optimising HIV care in countries with diverse medical systems is critical; however data on best practices for HIV healthcare delivery in resource-constrained settings are limited. This study aimed to understand patient characteristics and treatment outcomes from different HIV healthcare settings in Bangalore, India.</p> <p>Methods</p> <p>Participants from public, private and public-private HIV healthcare settings were recruited between 2007 and 2009 and were administered structured interviews by trained staff. Self-reported adherence was measured using the visual analogue scale to capture adherence over the past month, and a history of treatment interruptions (defined as having missed medications for more than 48 hours in the past three months). In addition, CD4 count and viral load (VL) were measured; genotyping for drug resistance-associated mutations was performed on those who were in virological failure (VL > 1000 copies/ml).</p> <p>Results</p> <p>A total of 471 individuals were included in the analysis (263 from the public facility, 149 from the public-private facility and 59 from the private center). Private facility patients were more likely to be male, with higher education levels and incomes. More participants reported ≥ 95% adherence among public and public-private groups compared to private participants (public 97%; private 88%; public-private 93%, p < 0.05). Treatment interruptions were lowest among public participants (1%, 10%, 5% respectively, p < 0.001). Although longer clinic waiting times were experienced by more public participants (48%, compared to private 27%, public-private 19%, p < 0.001), adherence barriers were highest among private (31%) compared with public (10%) and public-private (17%, p < 0.001) participants. Viral load was detectable in 13% public, 22% private and 9% public-private participants (p < 0.05) suggesting fewer treatment failures among public and public-private settings. Drug resistance mutations were found more frequently among private facility patients (20%) compared to those from the public (9%) or public-private facility (8%, p < 0.05).</p> <p>Conclusions</p> <p>Adherence and treatment success was significantly higher among patients from public and public-private settings compared with patients from private facilities. These results suggest a possible benefit of the standardized care delivery system established in public and public-private health facilities where counselling by a multi-disciplinary team of workers is integral to provision of ART. Strengthening and increasing public-private partnerships can enhance the success of national ART programs.</p>http://www.biomedcentral.com/1472-6963/11/277 |
| spellingShingle | Heylen Elsa DeCosta Ayesha Shet Anita Shastri Suresh Chandy Sara Ekstrand Maria High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems BMC Health Services Research |
| title | High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems |
| title_full | High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems |
| title_fullStr | High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems |
| title_full_unstemmed | High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems |
| title_short | High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems |
| title_sort | high rates of adherence and treatment success in a public and public private hiv clinic in india potential benefits of standardized national care delivery systems |
| url | http://www.biomedcentral.com/1472-6963/11/277 |
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