Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017
Abstract Background 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 res...
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doaj-4ff4b20d20044429b301ef9dba8134722020-11-25T03:42:08ZengBMCBMC Infectious Diseases1471-23342020-04-0120111310.1186/s12879-020-04978-9Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017Yu Wang0Scott Barnhart1Kesner Francois2Ermane Robin3Mireille Kalou4Georges Perrin5Lara Hall6Jean Baptiste Koama7Elisma Marinho8Jean Gabriel Balan9Jean Guy Honoré10Nancy Puttkammer11Department of Global Health, University of WashingtonDepartments of Medicine and Global Health, University of WashingtonNational AIDS Control Program, Haiti Ministry of Public Health and Population (PNLS/MSPP)National AIDS Control Program, Haiti Ministry of Public Health and Population (PNLS/MSPP)Division of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and PreventionDivision of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and PreventionDivision of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and PreventionDivision of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and PreventionCentre Haïtien pour le Renforcement du Système de SantéCentre Haïtien pour le Renforcement du Système de SantéCentre Haïtien pour le Renforcement du Système de SantéDepartment of Global Health, University of WashingtonAbstract Background 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. Methods 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. Results 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. Conclusions 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.http://link.springer.com/article/10.1186/s12879-020-04978-9Viral loadVLSecond-line regimenARTAntiretroviral therapyART adherence |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yu Wang Scott Barnhart Kesner Francois Ermane Robin Mireille Kalou Georges Perrin Lara Hall Jean Baptiste Koama Elisma Marinho Jean Gabriel Balan Jean Guy Honoré Nancy Puttkammer |
spellingShingle |
Yu Wang Scott Barnhart Kesner Francois Ermane Robin Mireille Kalou Georges Perrin Lara Hall Jean Baptiste Koama Elisma Marinho Jean Gabriel Balan Jean Guy Honoré Nancy Puttkammer Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017 BMC Infectious Diseases Viral load VL Second-line regimen ART Antiretroviral therapy ART adherence |
author_facet |
Yu Wang Scott Barnhart Kesner Francois Ermane Robin Mireille Kalou Georges Perrin Lara Hall Jean Baptiste Koama Elisma Marinho Jean Gabriel Balan Jean Guy Honoré Nancy Puttkammer |
author_sort |
Yu Wang |
title |
Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017 |
title_short |
Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017 |
title_full |
Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017 |
title_fullStr |
Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017 |
title_full_unstemmed |
Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010–2017 |
title_sort |
expanded access to viral load testing and use of second line regimens in haiti: time trends from 2010–2017 |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2020-04-01 |
description |
Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
topic |
Viral load VL Second-line regimen ART Antiretroviral therapy ART adherence |
url |
http://link.springer.com/article/10.1186/s12879-020-04978-9 |
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