Use of a Comprehensive HIV Care Cascade for Evaluating HIV Program Performance: Findings From 4 Sub-Saharan African Countries

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  McNairy, Margaret L. ; Lamb, Matthew R. ; Abrams, Elaine J. ; Elul, Batya ; Sahabo, Ruben ; Hawken, Mark P. ; Mussa, Antonio ; Zwede, Ayele ; Justman, Jessica ; El-Sadr, Wafaa M.
• Description:
  Background ; The traditional HIV treatment cascade has been noted to have limitations. A proposed comprehensive HIV care cascade that uses cohort methodology offers additional information as it accounts for all patients. Using data from 4 countries, we compare patient outcomes using both approaches. ; Methods ; Data from 390,603 HIV-infected adults (>15 years) enrolled at 217 facilities in Kenya, Mozambique, Rwanda, and Tanzania from 2005 to 2011 were included. Outcomes of all patients at 3, 6, and 12 months after enrollment were categorized as optimal, suboptimal, or poor. Optimal outcomes included retention in care, antiretroviral therapy (ART) initiation, and documented transfer. Suboptimal outcomes included retention in care without ART initiation among eligible patients or those without eligibility data. Poor outcomes included loss to follow-up and death. ; Results ; The comprehensive HIV care cascade demonstrated that at 3, 6 and 12 months, 58%, 51%, and 49% of patients had optimal outcomes; 22%, 12%, and 7% had suboptimal outcomes, and 20%, 37% and 44% had poor outcomes. Of all patients enrolled in care, 56% were retained in care at 12 months after enrollment. In comparison, the traditional HIV treatment cascade found 89% of patients enrolled in HIV care were assessed for ART eligibility, of whom 48% were determined to be ART-eligible with 70% initiating ART, and 78% of those initiated on ART retained at 12 months. ; Conclusions ; The comprehensive HIV care cascade follows outcomes of all patients, including pre-ART patients, who enroll in HIV care over time and uses quality of care parameters for categorizing outcomes. The comprehensive HIV care cascade provides complementary information to that of the traditional HIV treatment cascade and is a valuable tool for monitoring HIV program performance.
• Keywords:
  • HIV
  • retention
  • antiretroviral
  • HIV care cascade
  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Aged
  • Anti-HIV Agents
  • CD4 Lymphocyte Count
  More +
• Source:
  J Acquir Immune Defic Syndr. 70(2):e44-e51
• Pubmed ID:
  26375466
• Pubmed Central ID:
  PMC5094356
• Document Type:
  Journal Article
• Funding:
  U2G PS001537/PS/NCHHSTP CDC HHSUnited States/ ; U62 PS223540/PS/NCHHSTP CDC HHSUnited States/ ; 5U2GPS001537/PHS HHSUnited States/ ; 5U62PS223540/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  70
• Issue:
  2
• Download URL:
  https://stacks.cdc.gov/view/cdc/42711/cdc_42711_DS1.pdf
• File Type:
  [PDF - 884.65 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:34712bc62b722a0c5fd992b8282463d7ddb240226daec309aaf15aad20df02c9