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Mbuagbaw L, Ongolo-Zogo C, Mendoza OC, Zani B, Morfaw F, Nyambi A, Wang A, Kiflen M, El-Kechen H, Leenus A, Youssef M, Rehman N, Hermans L, MacDonald V, Bertagnolio S. Guidelines are needed for studies of pre-treatment HIV drug resistance: a methodological study. BMC Med Res Methodol 2021; 21:76. [PMID: 33874897 PMCID: PMC8056637 DOI: 10.1186/s12874-021-01258-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/25/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The expansion of access to antiretroviral therapy (ART) has been accompanied by an increase in pre-treatment drug resistance (PDR). While it is critical to monitor the increasing prevalence of PDR across countries and populations to inform optimal regimen selection, the completeness of reporting is often suboptimal, limiting the interpretation and generalizability of the results. Indeed, there is no formal guidance on how studies investigating the prevalence of drug resistance should be reported. Thus, we sought to determine the completeness of reporting in studies of PDR and the factors associated with sub-optimal reporting to ascertain the need for guidelines. METHODS As part of a systematic review on the global prevalence of PDR in key populations (men who have sex with men, sex workers, transgender people, people who inject drugs and people in prisons), we searched 10 electronic databases until January 2019. We extracted information on selected study characteristics useful for interpreting prevalence data. Data were extracted in duplicate. Analyses of variance and correlation were used to explore factors that may explain the number of items reported. RESULTS We found 650 studies of which 387 were screened as full text and 234 were deemed eligible. The included studies were published between 1997 and 2019 and included a median of 239 (quartile 1 = 101; quartile 3 = 778) participants. Most studies originated from high-income countries (125/234; 53.0%). Of 23 relevant data items, including study design, setting, participant sociodemographic characteristics, HIV risk factors, type of resistance test conducted, definition of resistance, the mean (standard deviation) number of items reported was 13 (2.2). We found that more items were reported in studies published more recently (r = 0.20; p < 0.002) and in studies at low risk of bias (F [2231] = 8.142; p < 0.001). CONCLUSIONS Incomplete reporting in studies on PDR makes characterising levels of PDR in subpopulations across countries challenging. Hence, guidelines are needed to define a minimum set of variables to be included in such studies.
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Affiliation(s)
- Lawrence Mbuagbaw
- 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.
| | - Clémence Ongolo-Zogo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- McMaster Health Forum, Hamilton, ON, Canada
| | - Olivia C Mendoza
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Frederick Morfaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | | | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Michel Kiflen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Hussein El-Kechen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Alvin Leenus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mark Youssef
- School of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nadia Rehman
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lucas Hermans
- Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Virginia MacDonald
- Department of HIV, Hepatitis, and Sexually Transmitted Diseases, World Health Organization, Geneva, Switzerland
| | - Silvia Bertagnolio
- Department of HIV, Hepatitis, and Sexually Transmitted Diseases, World Health Organization, Geneva, Switzerland
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The impact of routine HIV drug resistance testing in Ontario: A controlled interrupted time series study. PLoS One 2021; 16:e0246766. [PMID: 33798201 PMCID: PMC8018617 DOI: 10.1371/journal.pone.0246766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Lodi S, Günthard HF, Dunn D, Garcia F, Logan R, Jose S, Bucher HC, Scherrer AU, Schneider MP, Egger M, Glass TR, Reiss P, van Sighem A, Boender TS, Phillips AN, Porter K, Hawkins D, Moreno S, Monge S, Paraskevis D, Simeon M, Vourli G, Sabin C, Hernán MA. Effect of immediate initiation of antiretroviral treatment on the risk of acquired HIV drug resistance. AIDS 2018; 32:327-335. [PMID: 29135583 PMCID: PMC5758415 DOI: 10.1097/qad.0000000000001692] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We estimated and compared the risk of clinically identified acquired drug resistance under immediate initiation [the currently recommended antiretroviral therapy (ART) initiation strategy], initiation with CD4 cell count less than 500 cells/μl and initiation with CD4 cell count less than 350 cells/μl. DESIGN Cohort study based on routinely collected data from the HIV-CAUSAL collaboration. METHODS For each individual, baseline was the earliest time when all eligibility criteria (ART-naive, AIDS free, and others) were met after 1999. Acquired drug resistance was defined using the Stanford classification as resistance to any antiretroviral drug that was clinically identified at least 6 months after ART initiation. We used the parametric g-formula to adjust for time-varying (CD4 cell count, HIV RNA, AIDS, ART regimen, and drug resistance testing) and baseline (calendar period, mode of acquisition, sex, age, geographical origin, ethnicity and cohort) characteristics. RESULTS In 50 981 eligible individuals, 10% had CD4 cell count more than 500 cells/μl at baseline, and 63% initiated ART during follow-up. Of 2672 tests for acquired drug resistance, 794 found resistance. The estimated 7-year risk (95% confidence interval) of acquired drug resistance was 3.2% (2.8,3.5) for immediate initiation, 3.1% (2.7,3.3) for initiation with CD4 cell count less than 500 cells/μl, and 2.8% (2.5,3.0) for initiation with CD4 cell count less than 350 cells/μl. In analyses restricted to individuals with baseline in 2005-2015, the corresponding estimates were 1.9% (1.8, 2.5), 1.9% (1.7, 2.4), and 1.8% (1.7, 2.2). CONCLUSION Our findings suggest that the risk of acquired drug resistance is very low, especially in recent calendar periods, and that immediate ART initiation only slightly increases the risk. It is unlikely that drug resistance will jeopardize the proven benefits of immediate ART initiation.
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Affiliation(s)
- Sara Lodi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | | | - Roger Logan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Marie-Paule Schneider
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, Geneva
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute
- University of Basel, Basel, Switzerland
| | - Peter Reiss
- Stichting HIV Monitoring
- Division of Infectious Diseases, Department of Global Health, Academic Medical Centre, University of Amsterdam
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | | | | | | | | | | | - Santiago Moreno
- IRYCIS, Ramón y Cajal Hospital
- University of Alcalá de Henares
| | - Susana Monge
- University of Alcalá de Henares
- National Centre of Epidemiology - ISCIII, Madrid, Spain
| | | | | | - Georgia Vourli
- National and Kapodistrian University of Athens Medical School, Athens
| | | | - Miguel A Hernán
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA
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Benoit AC, Younger J, Beaver K, Jackson R, Loutfy M, Masching R, Nobis T, Nowgesic E, O'Brien-Teengs D, Whitebird W, Zoccole A, Hull M, Jaworsky D, Rachlis A, Rourke S, Burchell AN, Cooper C, Hogg R, Klein MB, Machouf N, Montaner J, Tsoukas C, Raboud J. A comparison of virological suppression and rebound between Indigenous and non-Indigenous persons initiating combination antiretroviral therapy in a multisite cohort of individuals living with HIV in Canada. Antivir Ther 2016; 22:325-335. [PMID: 27925609 DOI: 10.3851/imp3114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART). METHODS Data were from the Canadian Observational Cohort collaboration; eight studies of treatment-naive persons with HIV initiating cART after 1/1/2000. Fine and Gray models were used to estimate the effect of ethnicity on time to virological suppression (two consecutive viral loads [VLs] <50 copies/ml at least 3 months apart) after adjusting for the competing risk of death and time until virological rebound (two consecutive VLs >200 copies/ml at least 3 months apart) following suppression. RESULTS Among 7,080 participants were 497 Indigenous persons of whom 413 (83%) were from British Columbia. The cumulative incidence of suppression 1 year after cART initiation was 54% for Indigenous persons, 77% for Caucasian and 80% for African, Caribbean or Black (ACB) persons. The cumulative incidence of rebound 1 year after suppression was 13% for Indigenous persons, 6% for Caucasian and 7% for ACB persons. Indigenous persons were less likely to achieve suppression than Caucasian participants (aHR=0.58, 95% CI 0.50, 0.68), but not more likely to experience rebound (aHR=1.03, 95% CI 0.84, 1.27) after adjusting for age, gender, injection drug use, men having sex with men status, province of residence, baseline VL and CD4+ T-cell count, antiretroviral class and year of cART initiation. CONCLUSIONS Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.
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Affiliation(s)
- Anita C Benoit
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Building Bridges Team, Toronto, ON & Vancouver, BC, Canada
| | - Jaime Younger
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | | | - Randy Jackson
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,McMaster University, Hamilton, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Renée Masching
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Canadian Aboriginal AIDS Network, Dartmouth, NS, Canada
| | - Tony Nobis
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON, Canada
| | - Earl Nowgesic
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Doe O'Brien-Teengs
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Lakehead University, Thunder Bay, ON, Canada
| | - Wanda Whitebird
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON, Canada
| | - Art Zoccole
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,2-Spirited People of the 1st Nations, Toronto, ON, Canada
| | - Mark Hull
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Denise Jaworsky
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Sean Rourke
- Ontario HIV Treatment Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada.,Department of Psychiatry, St Michael's Hospital, Toronto, ON, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.,Centre for Urban Health Solutions, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Hogg
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Marina B Klein
- Department of Medicine, McGill University Health Centre Research Institute, Montréal, QC, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Nima Machouf
- Clinique Médicale L'Actuel, Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Tsoukas
- Experimental Medicine, McGill University, Montréal, QC, Canada
| | - Janet Raboud
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Toronto General Research Institute, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting. J Int AIDS Soc 2016; 19:20617. [PMID: 27094914 PMCID: PMC4837333 DOI: 10.7448/ias.19.1.20617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/03/2016] [Accepted: 03/02/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In many settings worldwide, members of indigenous groups experience a disproportionate burden of HIV. In Canada, there is an urgent need to improve HIV treatment outcomes for indigenous people living with HIV (IPLWH), to not only reduce HIV/AIDS-associated morbidity and mortality but also curb elevated rates of viral transmission. Thus, by comparing indigenous and non-indigenous participants in an ongoing longitudinal cohort of HIV-positive people who use illicit drugs, we sought to investigate longitudinal changes in three HIV treatment indicators for IPLWH who use illicit drugs during a community-wide treatment-as-prevention (TasP) initiative in British Columbia, Canada. METHODS We used data from the ACCESS study, an ongoing observational prospective cohort of HIV-positive illicit drug users recruited from community settings in Vancouver, British Columbia. Cohort data are linked to comprehensive retrospective and prospective clinical records in a setting of no-cost HIV/AIDS treatment and care. We used multivariable generalized estimating equations (GEE) to evaluate longitudinal changes in the proportion of participants with exposure to antiretroviral therapy (ART) in the previous 180 days, optimal adherence to ART (i.e. ≥ 95% vs. < 95%) and non-detectable HIV-1 RNA viral load (VL <50 copies/mL plasma). RESULTS Between 2005 and 2014, 845 individuals were recruited, including 326 (39%) self-reporting any indigenous ancestry, and contributed 6732 interviews and 13,495 VL measurements. Among indigenous participants, the proportion with recent ART increased from 51 to 94% and non-detectable VL from 23 to 65%. In multivariable models, later interview period was positively associated with recent ART (adjusted odds ratio (AOR) = 1.16 per interview period, 95% confidence interval (CI): 1.11 to 1.20) and non-detectable VL (AOR = 1.07, 95% CI: 1.04 to 1.10). In adjusted models comparing indigenous and non-indigenous participants, we did not observe differences between the two groups (all p>0.1). CONCLUSIONS In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants. The current findings highlight the important role of TasP on vulnerable populations in this setting and contribute to the evidence base supporting the immediate scale-up of ART to address HIV/AIDS-associated morbidity, mortality and viral transmission.
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Abstract
OBJECTIVES To describe regional differences and trends in resistance testing among individuals experiencing virological failure and the prevalence of detected resistance among those individuals who had a genotypic resistance test done following virological failure. DESIGN Multinational cohort study. METHODS Individuals in EuroSIDA with virological failure (>1 RNA measurement >500 on ART after >6 months on ART) after 1997 were included. Adjusted odds ratios (aORs) for resistance testing following virological failure and aORs for the detection of resistance among those who had a test were calculated using logistic regression with generalized estimating equations. RESULTS Compared to 74.2% of ART-experienced individuals in 1997, only 5.1% showed evidence of virological failure in 2012. The odds of resistance testing declined after 2004 (global P < 0.001). Resistance was detected in 77.9% of the tests, NRTI resistance being most common (70.3%), followed by NNRTI (51.6%) and protease inhibitor (46.1%) resistance. The odds of detecting resistance were lower in tests done in 1997-1998, 1999-2000 and 2009-2010, compared to those carried out in 2003-2004 (global P < 0.001). Resistance testing was less common in Eastern Europe [aOR 0.72, 95% confidence interval (CI) 0.55-0.94] compared to Southern Europe, whereas the detection of resistance given that a test was done was less common in Northern (aOR 0.29, 95% CI 0.21-0.39) and Central Eastern (aOR 0.47, 95% CI 0.29-0.76) Europe, compared to Southern Europe. CONCLUSIONS Despite a concurrent decline in virological failure and testing, drug resistance was commonly detected. This suggests a selective approach to resistance testing. The regional differences identified indicate that policy aiming to minimize the emergence of resistance is of particular relevance in some European regions, notably in the countries in Eastern Europe.
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Hauser RG, Jackson BR, Shirts BH. A bayesian approach to laboratory utilization management. J Pathol Inform 2015; 6:10. [PMID: 25774321 PMCID: PMC4355837 DOI: 10.4103/2153-3539.151921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/27/2014] [Indexed: 11/09/2022] Open
Abstract
Background: Laboratory utilization management describes a process designed to increase healthcare value by altering requests for laboratory services. A typical approach to monitor and prioritize interventions involves audits of laboratory orders against specific criteria, defined as rule-based laboratory utilization management. This approach has inherent limitations. First, rules are inflexible. They adapt poorly to the ambiguity of medical decision-making. Second, rules judge the context of a decision instead of the patient outcome allowing an order to simultaneously save a life and break a rule. Third, rules can threaten physician autonomy when used in a performance evaluation. Methods: We developed an alternative to rule-based laboratory utilization. The core idea comes from a formula used in epidemiology to estimate disease prevalence. The equation relates four terms: the prevalence of disease, the proportion of positive tests, test sensitivity and test specificity. When applied to a laboratory utilization audit, the formula estimates the prevalence of disease (pretest probability [PTP]) in the patients tested. The comparison of PTPs among different providers, provider groups, or patient cohorts produces an objective evaluation of laboratory requests. We demonstrate the model in a review of tests for enterovirus (EV) meningitis. Results: The model identified subpopulations within the cohort with a low prevalence of disease. These low prevalence groups shared demographic and seasonal factors known to protect against EV meningitis. This suggests too many orders occurred from patients at low risk for EV. Conclusion: We introduce a new method for laboratory utilization management programs to audit laboratory services.
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Affiliation(s)
- Ronald G Hauser
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian R Jackson
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA ; ARUP Laboratories, Salt Lake City, Utah, USA
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
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Duncan KC, Salters K, Forrest JI, Palmer AK, Wang H, O'Brien N, Parashar S, Cescon AM, Samji H, Montaner JS, Hogg RS. Cohort Profile: Longitudinal Investigations into Supportive and Ancillary health services. Int J Epidemiol 2012; 42:947-55. [PMID: 22461127 DOI: 10.1093/ije/dys035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The Longitudinal Investigations into Supportive and Ancillary health services (LISA) study is a cohort of people living with HIV/AIDS who have ever accessed anti-retroviral therapy (ART) in British Columbia, Canada. The LISA study was developed to better understand the outcomes of people living with HIV with respect to supportive services use, socio-demographic factors and quality of life. Between July 2007 and January 2010, 1000 participants completed an interviewer-administered questionnaire that included questions concerning medical history, substance use, social and medical support services, food and housing security and other social determinants of health characteristics. Of the 1000 participants, 917 were successfully linked to longitudinal clinical data through the provincial Drug Treatment Program. Within the LISA cohort, 27% of the participants are female, the median age is 39 years and 32% identify as Aboriginal. Knowledge translation activities for LISA include the creation of plain language summaries, internet resources and arts-based engagement activities such as Photovoice.
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Affiliation(s)
- Katrina C Duncan
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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9
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Cozzi-Lepri A, Paredes, Phillips AN, Clotet B, Kjaer J, Von Wyl V, Kronborg G, Castagna A, Bogner JR, Lundgren JD. The rate of accumulation of nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance in patients kept on a virologically failing regimen containing an NNRTI*. HIV Med 2011; 13:62-72. [PMID: 21848790 DOI: 10.1111/j.1468-1293.2011.00943.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Virological failure of first-generation nonnucleoside reverse transcriptase inhibitors (NNRTIs) can compromise the efficacy of etravirine as a result of the accumulation of NNRTI resistance mutations. How quickly NNRTI resistance accumulates in patients with a delayed switch from nevirapine or efavirenz despite virological failure, when these drugs are used as a component of combination antiretroviral therapy (cART), remains unclear. METHODS The rate of NNRTI resistance accumulation was estimated in patients in EuroSIDA with at least two available genotypic resistance tests (GRTs), provided that (1) the date of the first GRT (t0) was after the date of the first virological failure (VF) of an NNRTI, and (2) patients were receiving an NNRTI and HIV RNA was >500 HIV-1 RNA copies/mL in all measurements between GRTs. RESULTS A total of 227 patients were included in the study, contributing 467 GRT pairs. At baseline-t0, a median of 3 months after VF, 66% of patients had at least one NNRTI mutation: 103N (34%), 181C (22%) and 190A (20%) were the most common mutations. Overall, 180 additional NNRTI mutations were found to have accumulated over 295 years [1 new/1.6 years; 95% confidence interval (CI) 1.5-1.8]. The rate of accumulation was faster in the first 6 months from VF (1 new/1.1 years), and slower in patients exposed to nevirapine vs. those receiving efavirenz [relative risk (RR) 0.66; 95% CI 0.46-0.95; P=0.03]. CONCLUSIONS There is an initial phase of rapid accumulation of NNRTI mutations close to the time of VF followed by a phase of slower accumulation. We predict that it should take approximately one year of exposure to a virologically failing first-generation NNRTI-based cART regimen to reduce etravirine activity from fully susceptible to intermediate resistant, and possibly longer in patients kept on a failing nevirapine-containing regimen.
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Affiliation(s)
- A Cozzi-Lepri
- Department of Infection & Population Health, Division of Population Health, University College London, London, UK.
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