Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017
Open Access
- 16 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 20 (1), 1-13
- https://doi.org/10.1186/s12879-020-04978-9
Abstract
Haiti initiated the scale-up of HIV viral load (VL) testing in 2015–2016, with plans to achieve 100% coverage for all patients on antiretroviral therapy (ART) for treatment of HIV/AIDS. In the absence of HIV drug susceptibility testing, VL testing is a key tool for monitoring response to ART and optimizing treatment results. This study describes trends in expanded use of VL testing, VL results, and use of second-line ART regimens, and explores the association between VL testing and second-line regimen switching in Haiti from 2010 to 2017. We conducted a retrospective cohort study with 66,042 patients drawn from 88 of Haiti’s 160 national ART clinics. Longitudinal data from the iSanté electronic data system was used to analyze the trends of interest. We described patients’ VL testing status in five categories based on up to two most recent VL test results: no test; suppressed; unsuppressed followed by no test; re-suppressed; and confirmed failure. Among those with confirmed failure, we described ART adherence level. Finally, we used Cox proportional hazards regression to estimate the risk of second-line regimen switching by VL testing status, after adjusting for other individual characteristics. The number of patients who had tests done increased annually from 11 in 2010 to 18,828 in the first 9 months of 2017, while the number of second-line regimen switches rose from 21 to 279 during this same period. Compared with patients with no VL test, the hazard ratio (HR) for switching to a second-line regimen was 22.2 for patients with confirmed VL failure (95% confidence interval [CI] for HR: 18.8–26.3; p < 0.005) after adjustment for individual characteristics. Among patients with confirmed VL failure, 44.7% had strong adherence, and fewer than 20% of patients switched to a second-line regimen within 365 days of VL failure. Haiti has significantly expanded access to VL testing since 2016. In order to promote optimal patient health outcomes, it is essential for Haiti to continue broadening access to confirmatory VL testing, to expand evidence-based initiatives to promote strong ART adherence, and to embrace timely switching for patients with confirmed ART failure despite strong ART adherence.Funding Information
- Centers for Disease Control and Prevention (NU2GGH001130)
- National Institute of Allergy and Infectious Diseases (AI027757)
This publication has 22 references indexed in Scilit:
- Success factors for implementing and sustaining a mature electronic medical record in a low-resource setting: a case study of iSanté in HaitiHealth Policy and Planning, 2017
- Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysisThe Lancet HIV, 2015
- Medication Possession Ratio Associated with Short-Term Virologic Response in Individuals Initiating Antiretroviral Therapy in NamibiaPLOS ONE, 2013
- Pharmacy and Self-Report Adherence Measures to Predict Virological Outcomes for Patients on Free Antiretroviral Therapy in Tamil Nadu, IndiaAIDS and Behavior, 2013
- Implementation and expansion of an electronic medical record for HIV care and treatment in Haiti: An assessment of system use and the impact of large-scale disruptionsInternational Journal of Medical Informatics, 2012
- Prediction of Treatment Failure Using 2010 World Health Organization Guidelines Is Associated With High Misclassification Rates and Drug Resistance Among HIV-Infected Cambodian ChildrenClinical Infectious Diseases, 2012
- Outcomes of antiretroviral treatment in programmes with and without routine viral load monitoring in southern AfricaAIDS, 2011
- Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectivesThe Lancet Infectious Diseases, 2010
- Diagnosis of antiretroviral therapy failure in Malawi: poor performance of clinical and immunological WHO criteriaTropical Medicine & International Health, 2009
- Measurement of Adherence in Pharmacy Administrative Databases: A Proposal for Standard Definitions and Preferred MeasuresAnnals of Pharmacotherapy, 2006