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

Anita Shet, Ayesha Decosta, Elsa Heylen, Suresh Shastri, Sara Chandy, Maria Ekstrand

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods. 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). Results: 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). Conclusions: 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.

Original languageEnglish (US)
Article number277
JournalBMC Health Services Research
Volume11
DOIs
StatePublished - 2011
Externally publishedYes

Fingerprint

India
HIV
Public Facilities
Viral Load
Delivery of Health Care
Drug Resistance
Therapeutics
Public-Private Sector Partnerships
Mutation
Health Facilities
CD4 Lymphocyte Count
Treatment Failure
Visual Analog Scale
Practice Guidelines
Private Facilities
Counseling
Acquired Immunodeficiency Syndrome
Public Health
Interviews
Education

ASJC Scopus subject areas

  • Health Policy

Cite this

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. / Shet, Anita; Decosta, Ayesha; Heylen, Elsa; Shastri, Suresh; Chandy, Sara; Ekstrand, Maria.

In: BMC Health Services Research, Vol. 11, 277, 2011.

Research output: Contribution to journalArticle

@article{169f65689e5f4e1f9a22d0f4a93b2c38,
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",
abstract = "Background: 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. Methods. 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). Results: 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). Conclusions: 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.",
author = "Anita Shet and Ayesha Decosta and Elsa Heylen and Suresh Shastri and Sara Chandy and Maria Ekstrand",
year = "2011",
doi = "10.1186/1472-6963-11-277",
language = "English (US)",
volume = "11",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",

}

TY - JOUR

T1 - High rates of adherence and treatment success in a public and public-private HIV clinic in India

T2 - Potential benefits of standardized national care delivery systems

AU - Shet, Anita

AU - Decosta, Ayesha

AU - Heylen, Elsa

AU - Shastri, Suresh

AU - Chandy, Sara

AU - Ekstrand, Maria

PY - 2011

Y1 - 2011

N2 - Background: 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. Methods. 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). Results: 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). Conclusions: 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.

AB - Background: 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. Methods. 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). Results: 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). Conclusions: 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.

UR - http://www.scopus.com/inward/record.url?scp=80054070942&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054070942&partnerID=8YFLogxK

U2 - 10.1186/1472-6963-11-277

DO - 10.1186/1472-6963-11-277

M3 - Article

C2 - 22004573

AN - SCOPUS:80054070942

VL - 11

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

M1 - 277

ER -