Structure and quality of outpatient care for people living with an HIV infection

ABSTRACT

Policy-makers and clinicians are faced with a gap of evidence to guide policy on standards for HIV outpatient care. Ongoing debates include which settings of care improve health outcomes, and how many HIV-infected patients a health-care provider should treat to gain and maintain expertise. In this article, we evaluate the studies that link health-care facility and care provider characteristics (i.e., structural factors) to health outcomes in HIV-infected patients. We searched the electronic databases MEDLINE, PUBMED, and EMBASE from inception until 1 January 2015. We included a total of 28 observational studies that were conducted after the introduction of combination antiretroviral therapy in 1996. Three aspects of the available research linking the structure to quality of HIV outpatient care were evaluated: (1) assessed structural characteristics (i.e., health-care facility and care provider characteristics); (2) measures of quality of HIV outpatient care; and (3) reported associations between structural characteristics and quality of care. Rather than scarcity of data, it is the diversity in methodology in the identified studies and the inconsistency of their results that led us to the conclusion that the scientific evidence is too weak to guide policy in HIV outpatient care. We provide recommendations on how to address this heterogeneity in future studies and offer specific suggestions for further reading that could be of interest for clinicians and researchers.

KEYWORDS:

• HIV
• quality of health care
• treatment outcome
• ambulatory care facilities
• health personnel

Acknowledgements

E.A.N.E. collected all data and drafted the article. All authors edited, commented, and approved the final version of the article.

P.R. through his institution has received independent scientific grant support from Gilead Sciences, ViiV Healthcare, Merck & Co, Janssen Pharmaceutica, and Bristol-Myers Squibb (BMS). In addition, he serves on a scientific advisory board for Gilead Sciences and on a data and safety monitoring board for Janssen Pharmaceutica, for which his institution has received remunerations. K.B. serves on advisory boards for MSD, Gilead, BMS, Viiv, and Janssen for which he has received remuneration. All other authors report no potential conflicts.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Aids Fonds [2011015].