Disparities in HIV clinic care across Europe: findings from the EuroSIDA clinic survey

BMC Infectious Diseases

Research Article

Kelly Safreed-Harmon¹  Kamilla Grønborg Laut¹  Lars Peters¹  Jeffrey V. Lazarus¹  Irina Khromova²  Anna Lisa Ridolfo³  Amanda Mocroft⁴  Katarzyna Maciejewska⁵  Roxana Radoi⁶  Linos Vandekerckhove⁷  Margaret Johnson⁸  Gerd Fätkenheuer⁹ 

[1] CHIP – Centre for Health and Infectious Disease Research, Rigshospitalet, University of Copenhagen, Øster Alle 56, 5. sal, DK-2100, Copenhagen, Denmark;Centre for HIV/AIDS and infectious diseases, Kaliningrad, Russian Federation;Clinica delle Malattie Infettive, Milan, Italy;Department of Infection and Population Health, University College London, London, United Kingdom;Department of Infectious, Tropical Diseases and Aquired Immunodeficiencies of Pomeranian Medical University, Szczecin, Poland;Dr. Victor Babes Hospital, Bucharest, Romania;HIV Translational Research Unit (HTRU), Department of Internal Medicine, Ghent University and Ghent University Hospital, Ghent, Belgium;Royal Free and University College Medical School, London, United Kingdom;University Hospital Cologne, Cologne, Germany;

关键词: AIDS;    Health care delivery;    Health systems;    HIV;    Europe;   

DOI  :  10.1186/s12879-016-1685-x

 received in 2016-02-03, accepted in 2016-06-16,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundAlthough advances in HIV medicine have yielded increasingly better treatment outcomes in recent years, HIV-positive people with access to antiretroviral therapy (ART) still face complex health challenges. The EuroSIDA Study Group surveyed its clinics to explore regional differences in clinic services.MethodsThe EuroSIDA study is a prospective observational cohort study that began enrolling patients in 1994. In early 2014, we conducted a 59-item survey of the 98 then-active EuroSIDA clinics. The survey covered HIV clinical care and other aspects of patient care. The EuroSIDA East Europe study region (Belarus, Estonia, Lithuania, the Russian Federation and Ukraine) was compared to a “non-East Europe” study region comprised of all other EuroSIDA countries.ResultsA larger proportion of clinics in the East Europe group reported deferring ART in asymptomatic patients until the CD4 cell count dropped below 350 cells/mm3 (75 % versus 25 %, p = 0.0032). Considerably smaller proportions of East Europe clinics reported that resistance testing was provided before ART initiation (17 % versus 86 %, p < 0.0001) and that it was provided upon treatment failure (58 % versus 90 %, p = 0.0040). Only 33 % of East Europe clinics reported providing hepatitis B vaccination, compared to 88 % of other clinics (p < 0.0001). Only 50 % of East Europe clinics reported having access to direct-acting antivirals for hepatitis C treatment, compared to 89 % of other clinics (p = 0.0036). There was significantly less tuberculosis/HIV treatment integration in the East Europe group (27 % versus 84 % p < 0.0001) as well as significantly less screening for cardiovascular disease (58 % versus 90 %, p = 0.014); tobacco use (50 % versus 93 %, p < 0.0001); alcohol consumption (50 % versus 93 %, p < 0.0001); and drug use (58 % versus 87 %, p = 0.029).ConclusionsStudy findings demonstrate how specific features of HIV clinics differ across Europe. Significantly more East Europe clinics deferred ART in asymptomatic patients for longer, and significantly fewer East Europe clinics provided resistance testing before initiating ART or upon ART failure. The East Europe group of clinics also differed in regard to hepatitis B vaccination, direct-acting antiviral access, tuberculosis/HIV treatment integration and screening for other health issues. There is a need for further research to guide setting-specific decision-making regarding the optimal array of services at HIV clinics in Europe and worldwide.

【 授权许可】

CC BY   
© The Author(s). 2016