| Sažetak | Background: Combination antiretroviral therapy (CART) for HIV infection has resulted in outstanding decreases in HIV-related morbidity and mortality. However, these achievements need to be translated into practice. HIV care is an important element of the response to HIV and encompasses a continuum from early diagnosis to treatment outcomes. Systematic monitoring of successful entry into HIV care, retention in care and monitoring treatment outcomes are important elements of a response to HIV/AIDS.----- Objective: We evaluated several key indicators of the quality of care in adults living with HIV in Croatia. ----- Methods: In a retrospective analysis of reported data for 728 patients with HIV receiving medical care from 2007 to 2011, we determined performances for 6 HIV care healthcare indicators nationwide. These Indicators were: 1) patient access to HIV testing, 2) integration into care, 3) antiretroviral treatment guidelines compliance, 4) viral load suppression in patients starting CART, 5) retention into care and 6) success of care (survival after inclusion into care, viral suppression and CD4 cell count). A person was considered included into care if at least one CD4 cell count measurement was done in a calendar year. For the CD4 cell and viral load indicators the last measurement in a calendar year was used in the analysis. ----- Result: Of 316 entering care at UHID in the period 2007-2011, 186 (59%) were diagnosed late (CD4 cell count < 350 cells/mm³). Overall, 87% of were integrated into care within one month of diagnosis, the percentage ranged from 79 to 94% in individual calendar years. Among patients who ever had a CD4 cell count between 200 and 350 per mm³ and/or clinical AIDS the proportion of patients receiving CART was 82%, 89%, 89%, 91% and 94% for years 2007-2011 respectively. Of 228 patients who started CART in the period 2007-2010; 206 (90%) had a viral load measurement after 1-year (+- 90 days) of therapy. An undetectable viral load was found in 88% (viral load < 50 copies/ml of HIV-1 RNA) and 97% (viral load < 400 copies/ml) of these patients. Retention in care was good as measured by the proportion of patients not seen in care in the next calendar year. The total number of patients in care ranged from 412 in 2007 to 637 in 2011, and lost to follow-up was 7.3% in 2007 and 6.2% in 2011. Survival after inclusion into care was 95%, 93% and 93% at one, two or three years respectively. The median CD4 cell count of all patients in care increased from 426 cells/mm³ in 2007 to 524 cells/mm³ in 2011. The proportion of patients in care with a viral load < 400 copies/ml increased over time. ----- Conclusion: The quality of HIV care in Croatia is very good. Late presenters remain a problem and efforts to promote earlier HIV diagnosis should be undertaken. Our data was generated on a national level, in the future, it can be used to monitor HIV public health policy and prevention. ----- Keywords: Health care interventions, HIV, AIDS, Croatia, HIV quality of care. |
