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. 2012;7(11):e47859.
doi: 10.1371/journal.pone.0047859. Epub 2012 Nov 19.

Development and validation of a composite programmatic assessment tool for HIV therapy

Viviane D Lima  1 , Adrian Le, Bohdan Nosyk, Rolando Barrios, Benita Yip, Robert S Hogg, P Richard Harrigan, Julio S G Montaner
Affiliations

Development and validation of a composite programmatic assessment tool for HIV therapy

Viviane D Lima et al. PLoS One. 2012.

Abstract

Background: We developed and validated a new and simple metric, the Programmatic Compliance Score (PCS), based on the IAS-USA antiretroviral therapy management guidelines for HIV-infected adults, as a predictor of all-cause mortality, at a program-wide level. We hypothesized that non-compliance would be associated with the highest probability of mortality.

Methods and findings: 3543 antiretroviral-naive HIV-infected patients aged ≥19 years who initiated antiretroviral therapy between January 1, 2000 and August 31, 2009 in British Columbia (BC), Canada, were followed until August 31, 2010. The PCS is composed by six non-performance indicators based on the IAS-USA guidelines: (1) having <3 CD4 count tests in the first year after starting antiretroviral therapy; (2) having <3 plasma viral load tests in the first year after starting antiretroviral therapy; (3) not having drug resistance testing done prior to starting antiretroviral therapy; (4) starting on a non-recommended antiretroviral therapy regimen; (5) starting therapy with CD4 <200 cells/mm(3); and (6) not achieving viral suppression within 6 months since antiretroviral therapy initiation. The sum of these six indicators was used to develop the PCS score - higher score indicates poorer performance. The main outcome was all-cause mortality. Each PCS component was independently associated with mortality. In the mortality analysis, the odds ratio (OR) for PCS ≥4 versus 0 was 22.37 (95% CI 10.46-47.84).

Conclusions: PCS was strongly associated with all-cause mortality. These results lend independent validation to the IAS-USA treatment guidelines for HIV-infected adults. Further efforts are warranted to enhance the PCS as a means to further improve clinical outcomes. These should be specifically evaluated and targeted at healthcare providers and patients.

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Conflict of interest statement

Competing Interests: RSH, JSGM, and PRH have received honorariums, travel grants to attend conferences and research grants from pharmaceutical companies working in the area of HIV/AIDS. VDL, BN, RB, AL and BY declare no conflict.

Figures

Figure 1
Figure 1. Distribution of the programmatic compliance score over time.
See this image and copyright information in PMC

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