Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium

Abstract

IntroductionTimely descriptions of HIV service characteristics and their evolution over time across diverse settings are important for monitoring the scale-up of evidence-based program strategies, understanding the implementation landscape, and examining service delivery factors that influence HIV care outcomes.MethodsThe International epidemiology Databases to Evaluate AIDS (IeDEA) consortium undertakes periodic cross-sectional surveys on service availability and care at participating HIV treatment sites to characterize trends and inform the scientific agenda for HIV care and implementation science communities. IeDEA’s 2020 general site assessment survey was developed through a consultative, 18-month process that engaged diverse researchers in identifying content from previous surveys that should be retained for longitudinal analyses and in developing expanded and new content to address gaps in the literature. An iterative review process was undertaken to standardize the format of new survey questions and align them with best practices in survey design and measurement and lessons learned through prior IeDEA site assessment surveys.ResultsThe survey questionnaire developed through this process included eight content domains covered in prior surveys (patient population, staffing and community linkages, HIV testing and diagnosis, new patient care, treatment monitoring and retention, routine HIV care and screening, pharmacy, record-keeping and patient tracing), along with expanded content related to antiretroviral therapy (differentiated service delivery and roll-out of dolutegravir-based regimens); mental health and substance use disorders; care for pregnant/postpartum women and HIV-exposed infants; tuberculosis preventive therapy; and pediatric/adolescent tuberculosis care; and new content related to Kaposi’s sarcoma diagnostics, the impact of COVID-19 on service delivery, and structural barriers to HIV care. The survey was distributed to 238 HIV treatment sites in late 2020, with a 95% response rate.ConclusionIeDEA’s approach for site survey development approach has broad relevance for HIV research networks and other priority health conditions.

Service delivery challenges in HIV care during the first year of the COVID‐19 pandemic: results from a site assessment survey across the global IeDEA consortium

“…IeDEA's 2020 site assessment survey was a cross‐sectional survey of 238 HIV care and treatment clinics at academic and community‐based hospitals and health centres participating in the consortium in 2020 as described elsewhere [ 33 ]. The survey collected data on site characteristics, such as facility type and location, patient population served and routine HIV care (e.g.…”

Preexposure prophylaxis availability among health facilities participating in the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium

“…This strength notwithstanding, clinics participating in the IeDEA research consortium comprise a small subset of the health facilities providing PrEP-sites that may not be fully representative of PrEP service provision and expansion within countries, primarily because the IeDEA is largely focused on HIV treatment, rather than prevention, and it comprises many highvolume clinics focused on specialized HIV care rather than primary health services. Representativeness may further be impacted by the variation in site participation from year to year [16,23,24]. Additionally, it should be noted that IeDEA site assessment surveys rely on selfreport by respondents, which could result in bias due to recall errors and/or social desirability bias [16].…”

“…Sites participating in IeDEA are primarily public-sector health facilities providing HIV care and comprise a heterogenous mix of academic and community programs, ranging from rural health centers to tertiary referral hospitals. Every 3-5 years, IeDEA administers a site assessment survey among all sites to collect data on site characteristics and services available to patients [16]. Survey questions include: patient populations served (e.g.…”

Integration of HIV care into maternal and child health services in the global IeDEA consortium

“…Therefore, a systematic, hybrid sampling strategy was used to (i) purposefully sample sites that had completed prior IeDEA site surveys to facilitate future longitudinal analyses, and (ii) ensure that selected sites were representative of the larger programmatic cohort by randomly sampling sites stratified by location (urban vs. rural) in line with the clinic distribution within each programmatic cohort. Thus, 32 representative sites from the Southern Africa region (15% of active sites) were included in the site assessment, which included sites that were purposively sampled ( n = 5), randomly sampled ( n = 18), and those in IeDEA's database that are not part of a large programmatic cohort ( n = 9) ( 19 ).…”