Variation in HIV care and treatment outcomes by facility in South Africa, 2011 –2015: A cohort study

by Jacob Bor, Anna Gage, Dorina Onoya, Mhairi Maskew, Yorghos Tripodis, Matthew P. Fox, Adrian Puren, Sergio Carmona, Koleka Mlisana, William MacLeod BackgroundDespite widespread availability of HIV treatment, patient outcomes differ across facilities. We propose and evaluate an approach to measure quality of HIV care at health facilities in South Africa ’s national HIV program using routine laboratory data. Methods and findingsData were extracted from South Africa ’s National Health Laboratory Service (NHLS) Corporate Data Warehouse. All CD4 counts, viral loads (VLs), and other laboratory tests used in HIV monitoring were linked, creating a validated patient identifier. We constructed longitudinal HIV care cascades for all patients in the national HIV progr am, excluding data from the Western Cape and very small facilities. We then estimated for each facility in each year (2011 to 2015) the following cascade measures identified a priori as reflecting quality of HIV care: median CD4 count among new patients; retention 12 months after presentation; 12-mo nth retention among patients established in care; viral suppression; CD4 recovery; monitoring after an elevated VL. We used factor analysis to identify an underlying measure of quality of care, and we assessed the persistence of this quality measure over time. We then assessed spatiotemporal variati on and facility and population predictors in a multivariable regression context.We analyzed data on 3,265 facilities with a m...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research