Program Schedule

1551
The Patient-Centered Medical Home: A Reality for HIV Care in Nigeria

Session: Poster Abstract Session: HIV: Cascade of Care
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDSA Poster 1551 Ahonkhai Final 2014.pdf (1.2 MB)
  • Background: HIV care delivery in resource-limited settings (RLS) may serve as a new paradigm for chronic care in an environment where episodic acute care is the norm. Frameworks for evaluation of care systems are important to optimize clinic performance. The Patient-Centered Medical Home (PCMH) is one framework heralded for chronic medical care. Our objective was to adapt the PCMH framework for use in RLS, and evaluate the performance of HIV treatment programs in Nigeria according to this standard. Methods: The study was conducted at comprehensive HIV treatment centers in the AIDS Prevention Initiative in Nigeria (APIN) network. In June of 2013, APIN coordinated 36 sites providing care and treatment to nearly 100,000 people living with HIV and AIDS. We adapted the 2011 National Committee on Quality Assurance PCMH standard for HIV care in RLS. We administered a 50-item survey to medical directors at all sites incorporating five key domains of the PCHM describing: 1) access & continuity, 2) patient population management 3) evidence-based care, 4) self care & community resource promotion, and 5) performance improvement. Results: Thirty-three of 36 clinics completed the survey. Most clinics were public (86%) and in urban/semi-urban locales (65%). Seventy-nine percent had >5,000 patients in care. On a scale of 0-100, clinics scored highest in self-care & support 91% (range 63-100%), followed by patient population management 80% (72-81%), and performance improvement 78% (44-78%). Clinics scored lowest with the most performance variability in evidence-based care 65% (22-89%) and access/continuity 61% (33-80%). Average composite score across the domains studied was 74% (58-81%). Twenty-nine of 33 sites scored in the top 25th percentile for at least 1 domain. Factors including clinic type (public vs. private vs. faith-based), size, and urban or rural location did not statistically significantly predict composite scores. Conclusion: HIV treatment programs in Nigeria performed quite well within the PCMH framework; 88% had a high score in at least one domain highlighting an opportunity to share best practices. Clinics showed greatest room for improvement on access and continuity. The PCMH model may provide a useful framework for evaluating chronic HIV care delivery in RLS.
    Aimalohi Ahonkhai, MD, MPH1,2, Ifeyinwa Onwuatuelo, DMD, MPH3, Elena Losina, PhD4, Bolanle Banigbe, MD, MPH3, Juliet Adeola, BSc, MBA3, Timothy G. Ferris, MD, MPH5, Kenneth a. Freedberg, MD, MSc6, Susan Regan, PhD2 and Prosper Okonkwo, MD, FMPCH3, (1)Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, (2)Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, (3)AIDS Prevention Initiative in Nigeria, Abuja, Nigeria, (4)Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, (5)Partners Healthcare, Boston, MA, (6)Medical Practice Evaluation Center, Masschusetts General Hospital, Boston, MA

    Disclosures:

    A. Ahonkhai, None

    I. Onwuatuelo, None

    E. Losina, None

    B. Banigbe, None

    J. Adeola, None

    T. G. Ferris, None

    K. A. Freedberg, None

    S. Regan, None

    P. Okonkwo, None

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