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Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries

BACKGROUND: Viral load (VL) monitoring is an essential component of the care of HIV positive individuals. Rates of VL monitoring have been shown to vary by HIV risk factor and clinical characteristics. The objective of this study was to determine whether there are differences among regions in Canada...

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Autores principales: Raboud, Janet M, Loutfy, Mona R, Su, DeSheng, Bayoumi, Ahmed M, Klein, Marina B, Cooper, Curtis, Machouf, Nima, Rourke, Sean, Walmsley, Sharon, Rachlis, Anita, Harrigan, P Richard, Smieja, Marek, Tsoukas, Christos, Montaner, Julio SG, Hogg, Robert S
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844400/
https://www.ncbi.nlm.nih.gov/pubmed/20184766
http://dx.doi.org/10.1186/1471-2334-10-40
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author Raboud, Janet M
Loutfy, Mona R
Su, DeSheng
Bayoumi, Ahmed M
Klein, Marina B
Cooper, Curtis
Machouf, Nima
Rourke, Sean
Walmsley, Sharon
Rachlis, Anita
Harrigan, P Richard
Smieja, Marek
Tsoukas, Christos
Montaner, Julio SG
Hogg, Robert S
author_facet Raboud, Janet M
Loutfy, Mona R
Su, DeSheng
Bayoumi, Ahmed M
Klein, Marina B
Cooper, Curtis
Machouf, Nima
Rourke, Sean
Walmsley, Sharon
Rachlis, Anita
Harrigan, P Richard
Smieja, Marek
Tsoukas, Christos
Montaner, Julio SG
Hogg, Robert S
author_sort Raboud, Janet M
collection PubMed
description BACKGROUND: Viral load (VL) monitoring is an essential component of the care of HIV positive individuals. Rates of VL monitoring have been shown to vary by HIV risk factor and clinical characteristics. The objective of this study was to determine whether there are differences among regions in Canada in the rates of VL testing of HIV-positive individuals on combination antiretroviral therapy (cART), where the testing is available without financial barriers under the coverage of provincial health insurance programs. METHODS: The Canadian Observational Cohort (CANOC) is a collaboration of nine Canadian cohorts of HIV-positive individuals who initiated cART after January 1, 2000. The study included participants with at least one year of follow-up. Generalized Estimating Equation (GEE) regression models were used to determine the effect of geographic region on (1) the occurrence of an interval of 9 months or more between two consecutive recorded VL tests and (2) the number of days between VL tests, after adjusting for demographic and clinical covariates. Overall and regional annual rates of VL testing were also reported. RESULTS: 3,648 individuals were included in the analysis with a median follow-up of 42.9 months and a median of 15 VL tests. In multivariable GEE logistic regression models, gaps in VL testing >9 months were more likely in Quebec (Odds Ratio (OR) = 1.72, p < 0.0001) and Ontario (OR = 1.78, p < 0.0001) than in British Columbia and among injection drug users (OR = 1.68, p < 0.0001) and were less likely among older individuals (OR = 0.77 per 10 years, p < 0.0001), among men having sex with men (OR = 0.62, p < 0.0001), within the first year of cART (OR = 0.15, p < 0.0001), among individuals on cART at the time of the blood draw (OR = 0.34, p < 0.0001) and among individuals with VL < 50 copies/ml at the previous visit (OR = 0.56, p < .0001). CONCLUSIONS: Significant variation in rates of VL testing and the probability of a significant gap in testing were related to geographic region, HIV risk factor, age, year of cART initiation, type of cART regimen, being in the first year of cART, AIDS-defining illness and whether or not the previous VL was below the limit of detection.
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spelling pubmed-28444002010-03-24 Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries Raboud, Janet M Loutfy, Mona R Su, DeSheng Bayoumi, Ahmed M Klein, Marina B Cooper, Curtis Machouf, Nima Rourke, Sean Walmsley, Sharon Rachlis, Anita Harrigan, P Richard Smieja, Marek Tsoukas, Christos Montaner, Julio SG Hogg, Robert S BMC Infect Dis Research Article BACKGROUND: Viral load (VL) monitoring is an essential component of the care of HIV positive individuals. Rates of VL monitoring have been shown to vary by HIV risk factor and clinical characteristics. The objective of this study was to determine whether there are differences among regions in Canada in the rates of VL testing of HIV-positive individuals on combination antiretroviral therapy (cART), where the testing is available without financial barriers under the coverage of provincial health insurance programs. METHODS: The Canadian Observational Cohort (CANOC) is a collaboration of nine Canadian cohorts of HIV-positive individuals who initiated cART after January 1, 2000. The study included participants with at least one year of follow-up. Generalized Estimating Equation (GEE) regression models were used to determine the effect of geographic region on (1) the occurrence of an interval of 9 months or more between two consecutive recorded VL tests and (2) the number of days between VL tests, after adjusting for demographic and clinical covariates. Overall and regional annual rates of VL testing were also reported. RESULTS: 3,648 individuals were included in the analysis with a median follow-up of 42.9 months and a median of 15 VL tests. In multivariable GEE logistic regression models, gaps in VL testing >9 months were more likely in Quebec (Odds Ratio (OR) = 1.72, p < 0.0001) and Ontario (OR = 1.78, p < 0.0001) than in British Columbia and among injection drug users (OR = 1.68, p < 0.0001) and were less likely among older individuals (OR = 0.77 per 10 years, p < 0.0001), among men having sex with men (OR = 0.62, p < 0.0001), within the first year of cART (OR = 0.15, p < 0.0001), among individuals on cART at the time of the blood draw (OR = 0.34, p < 0.0001) and among individuals with VL < 50 copies/ml at the previous visit (OR = 0.56, p < .0001). CONCLUSIONS: Significant variation in rates of VL testing and the probability of a significant gap in testing were related to geographic region, HIV risk factor, age, year of cART initiation, type of cART regimen, being in the first year of cART, AIDS-defining illness and whether or not the previous VL was below the limit of detection. BioMed Central 2010-02-25 /pmc/articles/PMC2844400/ /pubmed/20184766 http://dx.doi.org/10.1186/1471-2334-10-40 Text en Copyright ©2010 Raboud et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Raboud, Janet M
Loutfy, Mona R
Su, DeSheng
Bayoumi, Ahmed M
Klein, Marina B
Cooper, Curtis
Machouf, Nima
Rourke, Sean
Walmsley, Sharon
Rachlis, Anita
Harrigan, P Richard
Smieja, Marek
Tsoukas, Christos
Montaner, Julio SG
Hogg, Robert S
Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries
title Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries
title_full Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries
title_fullStr Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries
title_full_unstemmed Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries
title_short Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries
title_sort regional differences in rates of hiv-1 viral load monitoring in canada: insights and implications for antiretroviral care in high income countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844400/
https://www.ncbi.nlm.nih.gov/pubmed/20184766
http://dx.doi.org/10.1186/1471-2334-10-40
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