Identifying Optimal HIV Care Approaches in Africa
Principal Investigator:
- Denis Nash, Ph.D., M.P.H., Columbia University Mailman School of Public Health
Co-Investigators:
- Batya Elul, Ph.D., M.Sc., Columbia University Mailman School of Public Health
- Wafaa El-Sadr, M.D., M.P.H., Columbia University Mailman School of Public Health
Abstract
This project endeavors to identify optimal approaches to HIV care and treatment in Africa by conducting a multi-site and multi-level operational research study of the characteristics of HIV care and treatment programs and outcomes among individuals receiving care at these sites. This research is unique in that it examines site-level and contextual factors associated with patient outcomes for patients in advanced stages of HIV disease receiving ART (both adult and pediatric) as well as patients in earlier stages of HIV receiving non-ART care. The specific aims are as follows:
- To assess the degree of variation in patient outcomes (e.g., adherence to ART, retention in care, immunological response to ART, and survival) across HIV care and treatment delivery sites, independent of the differences in the characteristics of patient-level factors (e.g., age, sex, stage of disease) across sites.
- To identify site-level and contextual factors that are associated with HIV care and treatment outcomes, after adjusting for patient-level factors.
- To assess the costs and clinical benefits of modifying site-level factors that appear to influence HIV care and treatment outcomes and quality adjusted life years (QALYs).
Data will be collected from two sources. First, we will extend our existing routine monitoring and evaluation field methods and data collection efforts at Columbia-supported President's Emergency Plan for AIDS Relief (PEPfAR) sites (n=29) in order to combine core HIV care and treatment data on patients across sites, including Mother-to-Child Transmission (MCTC)-Plus sites (n=14). The combined data set will include data on a growing number of patients at 43 sites throughout sub-Saharan Africa (including 26,107 patients, 9,687 (37%) of whom are on ART [8,752 adults and 935 children] as of June, 2005). Second, systematic site assessments will be conducted at the 43 Columbia-supported PEPFAR and MTCT-Plus sites every six months in order to capture information about site-level and contextual factors that may influence HIV care and treatment program outcomes. Data from systematic site assessments will be merged with data on patients receiving care and treatment. Using the final merged dataset with patient-level and site-level/contextual information, we will conduct data analyses to determine the relations between individual-level factors, site-level/contextual factors, and HIV care and treatment program outcomes. Finally, we will conduct a cost-benefit analysis to compare the clinical benefits and costs of various care models using cost estimates collected from a sample of sites during the study period.
This work is vital to identifying important programmatic aspects of HIV care and treatment programs for use in planning future programs or improving existing ones. The information gathered as part of this activity will suggest novel interventions or policies, which take into account factors at multiple levels, and could thereby improve care and treatment program outcomes in resource limited settings in the immediate future.