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Reasons for noncompliance with the national guidelines for initial antiretroviral therapy of HIV-infected patients in Spain, 2010-2015. Enferm Infecc Microbiol Clin 2019; 37:580-587. [PMID: 30982676 DOI: 10.1016/j.eimc.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Our aims were to investigate the adherence to national guidelines of initial antiretroviral therapy (ART) in the Spanish multicenter CoRIS cohort during the years 2010-2015, to identify the reasons for the prescription of nonrecommended treatments, and to explore the role of institutional constraints to guideline compliance. METHODS ART regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Physicians were asked the reasons for prescribing nonrecommended regimens. Factors associated with the prescription of non recommended regimens were assessed using multivariable logistic regression. RESULTS During the study period, 586 (10.7%) of 5479 patients who started ART were given a regimen not recommended in the guidelines. The most frequent reasons for prescribing nonrecommended regimens were: enrolment in clinical trials (43.3%), comorbidities and/or interactions (10.2%), pregnancy (8.7%), and cost (7.7%). Among 37 participating centers, 16 (43%), treating 3561 patients, reported limitations related with the cost of ART, and 20 (54%), treating 1365 patients, reported restrictions for prescribing at least one recommended antiretroviral. In multivariable analysis, a higher risk of receiving nonrecommended regimens was associated with male gender, HIV acquisition by heterosexual transmission, low viral loads, initiation of treatment during the years 2011 to 2015, and initiation of treatment in a center with restricted access to at least one antiretroviral drug. CONCLUSIONS Compliance to clinical guidelines was high. A high proportion of centres reported cost limitations for ART or restricted access to at least one recommended antiretroviral drug, with a significant impact on the choice of initial regimens.
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Viciana-Fernández P, Falcó V, Castaño M, de los Santos-Gil I, Olalla-Sierra J, Hernando A, Deig E, Clotet B, Knobel H, Podzamczer D, Pedrol PD. [Barriers to ART initiation in HIV infected subjects and with treatment indication in Spain. Why don't they start their treatment? Bridgap Study]. Enferm Infecc Microbiol Clin 2015; 33:397-403. [PMID: 25577557 DOI: 10.1016/j.eimc.2014.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/06/2014] [Accepted: 06/18/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In Spain, HIV treatment guidelines are well known and generally followed. However, in some patients there are no plans to initiate ART despite having treatment indications. The current barriers to ART initiation are presented. METHODS A cross-sectional survey including every HIV infected patient in care in 19 hospitals across Spain in 2012, with ≥1 indication to start ART according to 2011 national treatment guidelines, who had not been scheduled for ART initiation. Reasons for deferring treatment were categorized as follows (non-exclusive categories): a) The physician thinks the indication is not absolute and prefers to defer it; b) The patient does not want to start it; c) The physician thinks ART must be started, but there is some limitation to starting it, and d) The patient has undetectable viral load in absence of ART. RESULTS A total of 256 patients, out of 784 originally planned, were included. The large majority (84%) were male, median age 39 years, 57% MSM, 24% heterosexuals, and 16% IDUs. Median time since HIV diagnosis was 3 years, median CD4 count, 501 cells/mm3, median viral load 4.4 log copies/ml. Main ART indications were: CD4 count <500 cells/mm(3), 48%; having an uninfected sexual partner, 28%, and hepatitis C coinfection, 23%. Barriers due to, the physician, 55%; the patient, 28%; other limitations, 23%; and undetectable viral load, 6%. CONCLUSIONS The majority of subjects with ART indication were on it. The most frequent barriers among those who did not receive it were physician-related, suggesting that the relevance of the conditions that indicate ART may need reinforcing.
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Affiliation(s)
| | - Vicenç Falcó
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebrón, Barcelona, España
| | - Manuel Castaño
- Servicio de Enfermedades Infecciosas, Hospital Regional Carlos Haya, Málaga, España
| | | | | | - Asunción Hernando
- Unidad de VIH, Hospital Universitario 12 de Octubre, Universidad Europea de Madrid, Madrid, España
| | - Elisabet Deig
- Unidad de VIH-Servicio de Medicina Interna, Hospital General de Granollers, Granollers, España
| | | | - Hernando Knobel
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, España
| | - Daniel Podzamczer
- Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España
| | - Pere Domingo Pedrol
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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Cotte L, Bénet T, Vanhems P, Brochier C, Perpoint T, Ferry T, Chidiac C. The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study. BMC Infect Dis 2014; 14:596. [PMID: 25395106 PMCID: PMC4233095 DOI: 10.1186/s12879-014-0596-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/29/2014] [Indexed: 11/12/2022] Open
Abstract
Background Guidelines for antiretroviral treatment (cART) are published regularly, but there is little information regarding the effect of adherence to guidelines on patient outcomes. We assessed the effect of following the "when-to-start" and "what-to-start" guidelines, on treatment modifications, and on immunological and virological outcome at 12 months in a cohort of HIV-1 infected patients initiating cART from 2000 to 2010. Methods Consecutive HIV-1 infected patients, antiretroviral naive, initiating cART from 2000 to 2010 at a University Hospital were enrolled. HIV-2 infection, cART for prevention of mother-to-child transmission or during primary HIV-infection and unlicensed drugs were excluded. The respect or not of the "when-to-start" and "what-to-start" guidelines was based on French guidelines published from 2000 to 2010. Factors associated with cART modifications at 12 months and factors associated with an HIV viral load of <50 copies/mL at 12 months were assessed by univariate and multivariate logistic regression modeling. Variations in CD4 counts from baseline were assessed by univariate and multivariate linear regression. Results Of 1365 patients starting cART, 151 were treated outside "when-to-start" guidelines and 150 were treated outside "what-to-start" guidelines. Not using "when-to-start" guidelines was mainly related to early initiation in young men having sex with men, and was not associated with a significantly different outcome at 12 months. Treatments that did not follow "what-to-start" guidelines were not observed in any specific population and were associated with more treatment modifications and a poorer virological outcome at 12 months. Conclusions Adherence to "what-to-start" guidelines is associated with a better outcome at 12 months in HIV-infected patients initiating antiretroviral therapy. Efforts should be made to promote adherence to these guidelines.
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Suárez-García I, Sobrino-Vegas P, Tejada A, Viciana P, Ribas MA, Iribarren JA, Díaz Menéndez M, Rivero M, Arazo P, del Amo J, Moreno S. Compliance with national guidelines for HIV treatment and its association with mortality and treatment outcome: a study in a Spanish cohort. HIV Med 2013; 15:86-97. [DOI: 10.1111/hiv.12078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- I Suárez-García
- Infectious Diseases Unit; Infanta Sofía Hospital; Madrid Spain
| | | | - A Tejada
- Ramón y Cajal Hospital; Madrid Spain
| | - P Viciana
- Virgen del Rocío Hospital; Sevilla Spain
| | - MA Ribas
- Son Espases Hospital; Palma de Mallorca; Spain
| | | | | | - M Rivero
- Navarra Hospital; Pamplona Spain
| | - P Arazo
- Miguel Servet Hospital; Zaragoza Spain
| | - J del Amo
- National Epidemiology Center; Madrid Spain
| | - S Moreno
- Ramón y Cajal Hospital; Madrid Spain
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Rosas SR, Schouten JT, Cope MT, Kagan JM. Modeling the dissemination and uptake of clinical trials results. RESEARCH EVALUATION 2013; 22:179-186. [PMID: 24808630 PMCID: PMC3745267 DOI: 10.1093/reseval/rvt005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A select set of highly cited publications from the National Institutes of Health (NIH) HIV/AIDS Clinical Trials Networks was used to illustrate the integration of time interval and citation data, modeling the progression, dissemination, and uptake of primary research findings. Following a process marker approach, the pace of initial utilization of this research was measured as the time from trial conceptualization, development and implementation, through results dissemination and uptake. Compared to earlier studies of clinical research, findings suggest that select HIV/AIDS trial results are disseminated and utilized relatively rapidly. Time-based modeling of publication results as they meet specific citation milestones enabled the observation of points at which study results were present in the literature summarizing the evidence in the field. Evaluating the pace of clinical research, results dissemination, and knowledge uptake in synthesized literature can help establish realistic expectations for the time course of clinical trials research and their relative impact toward influencing clinical practice.
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Affiliation(s)
- Scott R Rosas
- Concept Systems, Inc., 136 East State Street, Ithaca, NY 14850-5546, Office of HIV/AIDS Network Coordination, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, E2-112, Seattle, WA 98109-1024 and Division of Clinical Research, NIAID, NIH, 6700B Rockledge Drive, Room 1102, Bethesda, MD 20892-7609
| | - Jeffrey T Schouten
- Concept Systems, Inc., 136 East State Street, Ithaca, NY 14850-5546, Office of HIV/AIDS Network Coordination, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, E2-112, Seattle, WA 98109-1024 and Division of Clinical Research, NIAID, NIH, 6700B Rockledge Drive, Room 1102, Bethesda, MD 20892-7609
| | - Marie T Cope
- Concept Systems, Inc., 136 East State Street, Ithaca, NY 14850-5546, Office of HIV/AIDS Network Coordination, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, E2-112, Seattle, WA 98109-1024 and Division of Clinical Research, NIAID, NIH, 6700B Rockledge Drive, Room 1102, Bethesda, MD 20892-7609
| | - Jonathan M Kagan
- Concept Systems, Inc., 136 East State Street, Ithaca, NY 14850-5546, Office of HIV/AIDS Network Coordination, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, E2-112, Seattle, WA 98109-1024 and Division of Clinical Research, NIAID, NIH, 6700B Rockledge Drive, Room 1102, Bethesda, MD 20892-7609
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Impact of Recommendation Updates in Well-Controlled Patients on Nonrecommended Antiretroviral Therapies. J Acquir Immune Defic Syndr 2013. [DOI: 10.1097/qai.0b013e31827b626a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marco A, Gallego C, Blanco XR, Puig A, Argüelles MJ, Moruno L. [An analysis of adherence to the "Recommendations for the treatment of human immunodeficiency virus-infected adults" in a penitentiary in Barcelona]. Enferm Infecc Microbiol Clin 2013; 31:392-5. [PMID: 23352212 DOI: 10.1016/j.eimc.2012.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/19/2012] [Accepted: 12/10/2012] [Indexed: 11/19/2022]
Abstract
AIM To analyze the adherence to the "Guidelines for the treatment of HIV-infected adults" among HIV-infected prison inmates. METHODS A cross-sectional study was conducted in 2010 in the Quatre Camins Prison (Barcelona, Spain). Epidemiological, clinical and therapeutic variables were collected. We verified whether antiretroviral therapy (ART) met the Guidelines and analyzed the variables associated with compliance using bivariate and multivariate analysis. RESULTS There were a total of 202 HIV infected prison inmates, 83.2% of whom were on ART. An undetectable viral load (VL) was observed in 80.4% of treated patients. The large majority (86.1%) met the guidelines, and 42.9% of non-compliance to guidelines was because the patients refused ART. More undetectable VL (P=.001; ORA: 4,30, 95%CI: 1,85 to 10.0) was found in those patients following the guidelines. CONCLUSION Compliance with the guidelines is high, and is significantly associated with undetectable VL. We suggest evaluating the quality of prescriptions periodically, and to correct them if needed.
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Affiliation(s)
- Andrés Marco
- Servicios Sanitarios Penitenciarios, Departamento de Justicia, Generalitat de Catalunya, Barcelona, España.
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Impacto presupuestario del tratamiento antirretroviral. Reflexión desde las guías de GESIDA. GACETA SANITARIA 2012; 26:541-6. [DOI: 10.1016/j.gaceta.2012.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 01/31/2023]
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Labhardt ND, Sello M, Lejone T, Ehmer J, Mokhantso M, Lynen L, Pfeiffer K. Adoption of new HIV treatment guidelines and drug substitutions within first-line as a measure of quality of care in rural Lesotho: health centers and hospitals compared. Trop Med Int Health 2012; 17:1245-54. [PMID: 22845835 DOI: 10.1111/j.1365-3156.2012.03051.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first-line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho. METHODS Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC- and a hospital-group. MAIN OUTCOME VARIABLES Type of backbone at ART-initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO-stage, baseline CD4-count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART-start, was used. RESULTS Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds-ratio 1.55; 95%CI: 1.32-1.81) and had a higher rate of drug substitutions while on first-line ART (2.39; 1.83-3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83-2.84). CONCLUSIONS Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART-programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them.
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Affiliation(s)
- Niklaus D Labhardt
- SolidarMed, Maseru, Lesotho Seboche Hospital, Botha-Bothe, Lesotho SolidarMed, Lucerne, Switzerland Institute of Tropical Medicine, Antwerp, Belgium
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Latthaphasavang V, Bouldouyre MA, Rachline A, Ponscarme D, Rozenbaum W, Mary JY, Delaugerre C, Molina JM. Antiretroviral Therapy Initiation in France. ACTA ACUST UNITED AC 2011; 11:40-6. [DOI: 10.1177/1545109711418362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives and Methods: Retrospective study of all patients who started antiretroviral therapy (ART) in 2007 in a single center in Paris, with baseline characteristics and 1-year outcome, to assess adherence to national guidelines. Results: We analyzed 118 patients. Time of ART initiation was in agreement with the guidelines for only 64 (54.2%) patients. Fifty patients (42%) started ART with AIDS or a CD4 count <200 cells/mm3. In all, 62 (52%) and 47 patients (40%) received a combination of 2 nucleoside analogues with efavirenz (EFV) and 1 ritonavir-boosted protease inhibitor (PI/r), respectively. Treatment regimens were in accordance with the guidelines for 114 patients (97%). At 1 year, 16 patients (13.5%) were lost to follow-up, only 5 (4.9%) experienced HIV disease progression or death, but 19 (18.6%) required hospitalization. Antiretroviral therapy was changed in 21 patients (21%). Ten patients (8.4%) experienced virologic failure. Conclusion: Antiretroviral therapy was in agreement with guidelines for the choice of combination but was often initiated too late.
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Affiliation(s)
| | - Marie-Anne Bouldouyre
- Department of Infectious Diseases, Saint Louis Hospital, AH-HP, and University of Paris Diderot, Paris, France
| | - Anne Rachline
- Department of Infectious Diseases, Saint Louis Hospital, AH-HP, and University of Paris Diderot, Paris, France
| | - Diane Ponscarme
- Department of Infectious Diseases, Saint Louis Hospital, AH-HP, and University of Paris Diderot, Paris, France
| | - Willy Rozenbaum
- Department of Infectious Diseases, Saint Louis Hospital, AH-HP, and University of Paris Diderot, Paris, France
| | - Jean-Yves Mary
- Department of Biostatistics, Saint Louis Hospital, AH-HP, and University of Paris Diderot, Paris, France
| | - Constance Delaugerre
- Laboratory of Virology, Saint Louis Hospital, AH-HP, and University of Paris Diderot, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint Louis Hospital, AH-HP, and University of Paris Diderot, Paris, France
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