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Tytuł:
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The impact of routine HIV drug resistance testing in Ontario: A controlled interrupted time series study.
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Autorzy:
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Mbuagbaw L; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada.; Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.
Logie CH; Women's College Research, Toronto, ON, Canada.; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
Thabane L; Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada.; Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON, Canada.; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
Smaill F; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Smieja M; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Burchell AN; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Rachlis B; Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Tarride JE; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.; McMaster Chair in Health Technology Management, McMaster University, Hamilton, ON, Canada.
Kroch A; Ontario HIV Treatment Network, Toronto, Ontario, Canada.
Mazzulli T; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Ontario, Canada.; Public Health Ontario Laboratory, Ontario, Canada.
Alvarez E; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.; Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada.
Lawson DO; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Nguyen F; ICES McMaster, McMaster University, Hamilton, Ontario, Canada.
Perez R; ICES McMaster, McMaster University, Hamilton, Ontario, Canada.
Seow H; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.; Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada.
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Źródło:
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PloS one [PLoS One] 2021 Apr 02; Vol. 16 (4), pp. e0246766. Date of Electronic Publication: 2021 Apr 02 (Print Publication: 2021).
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: San Francisco, CA : Public Library of Science
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MeSH Terms:
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Drug Resistance, Viral*
Anti-HIV Agents/*therapeutic use
HIV Infections/*drug therapy
Adult ; Anti-HIV Agents/pharmacology ; Female ; HIV/drug effects ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; Hospitalization ; Humans ; Interrupted Time Series Analysis ; Male ; Middle Aged ; Ontario/epidemiology ; Young Adult
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Substance Nomenclature:
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0 (Anti-HIV Agents)
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Entry Date(s):
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Date Created: 20210402 Date Completed: 20210914 Latest Revision: 20210914
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Update Code:
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20240104
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PubMed Central ID:
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PMC8018617
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DOI:
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10.1371/journal.pone.0246766
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PMID:
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33798201
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Background: Knowledge of HIV drug resistance informs the choice of regimens and ensures that the most efficacious options are selected. In January 2014, a policy change to routine resistance testing was implemented in Ontario, Canada. The objective of this study was to investigate the policy change impact of routine resistance testing in people with HIV in Ontario, Canada since January 2014.
Methods: We used data on people with HIV living in Ontario from administrative databases of the Institute for Clinical Evaluative Sciences (ICES) and Public Health Ontario (PHO), and ran ordinary least squares (OLS) models of interrupted time series to measure the levels and trends of 2-year mortality, 2-year hospitalizations and 2-year emergency department visits before (2005-2013) and after the policy change (2014-2017). Outcomes were collected in biannual periods, generating 18 periods before the intervention and 8 periods after. We included a control series of people who did not receive a resistance test within 3 months of HIV diagnosis.
Results: Data included 12,996 people with HIV, of which 8881 (68.3%) were diagnosed between 2005 and 2013, and 4115 (31.7%) were diagnosed between 2014 and 2017. Policy change to routine resistance testing within 3 months of HIV diagnosis led to a decreasing trend in 2-year mortality of 0.8% every six months compared to the control group. No significant differences in hospitalizations or emergency department visits were noted.
Interpretation: The policy of routine resistance testing within three months of diagnosis is beneficial at the population level.
Competing Interests: Ann N. Burchell is supported by an OHTN Leader Award, Canada Research Chair in Sexually Transmitted Infections and University of Toronto Department of Family and Community Medicine Non-Clinician Scientist Award. Carmen H. Logie is supported by a Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations and the Ontario Ministry of Research & Innovation. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
