Evaluating compliance with quality indicators of HIV and AIDS clinical care and analyzing those associated with mortality in the Democratic Republic of Congo.

Background: Since human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) infection have been identified, significant improvements have been made concerning its diagnosis and treatment. Few contributions have been made in the area of quality indicators in the Democratic Republic of Congo (DRC). To address this gap, a recent study conducted in the said area in 2023 resulted in the development of a comprehensive list of 88 indicators for assessing the quality of clinical care for HIV and AIDS. Out of these, 66 were identified as a core set of quality indicators for the assessment of HIV and AIDS clinical care. The aim of this study was to evaluate compliance with these quality indicators and determine those that are associated with mortality among people living with HIV and AIDS (PLWHA) in the DRC.
Methods: A retrospective cohort study was conducted at Panzi Hospital in Bukavu, South Kivu province of the DRC. The study population included PLWHA adult patients who were followed for a period of five years at the antiretroviral (ARV) clinic from January 2017 to December 2021. Descriptive analysis was performed to evaluate essential characteristics, and inferential statistics were performed including a multivariable logistic regression analysis performed to assess the association between selected clinical care indicators and PLWHA mortality, to estimate the odds ratios of mortality based on various factors, and to control for confounding variables.
Results: A total of 884 PLWHA were included. The level of compliance with the quality indicators was 78.79%. In the multivariate analysis, the quality-of-care indicators associated with mortality in the follow-up PLWHA on treatment were items 12 (Late diagnosis of HIV infection in specialized care), 24 (Assessment of resistance in cases of virologic failure), and 38 (Evaluation of Cardiac risk). Other factors associated with mortality were male sex, lower CD4 (< 500mm ³ ) and high viral load (> 50 copies/ml).
Conclusion: The level of compliance with the indicators was moderate. Some quality indicators were associated with mortality. These indicators are associated with delayed diagnosis of HIV infection, assessment of resistances in case of virologic failure, and evaluation of cardiac risk. Addressing gaps in adherence to these quality of care indicators (clinical care standards) could potentially reduce mortality rates and enhance the overall management of HIV and AIDS, particularly at Panzi Hospital in Bukavu, South Kivu Province, and in general in the DRC.
Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent to participate in the study was not required from the participants in the study because the data collection involved retrospective analysis of PLWHA records, and no direct contact with the PLWHA was required. According to national regulations and ethical guidelines, this type of research, which poses minimal risk to participants and involves pre-existing data, does not require individual consent. The study utilized anonymized data from PLWHA ' files, ensuring that personal identifiers were not disclosed. However, the study has received Ethical Approval (Approval number: BREC/00004657/2022) from the Biomedical Research Ethics Committee (BREC) at the University of KwaZulu-Natal Ethics Approval Board Institutional Review Board according to national regulations. In addition, a gatekeeper letter to conduct the study was obtained from the Healthcare facility as well. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Conflict of interest: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
(© 2024. The Author(s).)