Assessment of HIV Quality of Care in Cote d'Ivoire
The assessment, conducted in July and August 2008
The assessment found that for both the pre-ART and the ART cohorts, adherence to standards of care during the initial visit at the assessed sites was good. It was better among ART patients compared to pre-ART patients, and generally better among children compared to adults. Basic HIV care standards of HIV typing, weighing, clinical staging, and CD4+ T cell count assessment were all performed in at least 65% of patients. Adherence to standards of care was lower in the second semester of care for both cohorts. A number of clinical activities that were not conducted during clinical visits represent low-effort opportunities for providing care, including clinical staging, weight-taking, and patient counseling. Retention of patients in HIV care was found to be poor. Six months after initiating care, two out of three pre-ART patients and 45% of ART patients were lost to follow-up, comparing unfavorably with retention figures from other studies in the African context. While some sites worked with local groups providing community HIV care, coordination of this care was a challenge.
Reliance on information documented in medical records and registers limited this assessment, which was illustrated when medical record data for the ART cohort patients were compared with pharmacy data.