Quality of initial HIV care in Canada: extension of a composite programmatic assessment tool for HIV therapy. Issue 3 (6th July 2016)

• Record Type: Journal Article
• Authors: Kesselring, S; Cescon, A; Colley, G; Osborne, C; Zhang, W; Raboud, JM; Hosein, SR; Burchell, AN; Cooper, C; Klein, MB; Loutfy, M; Machouf, N; Montaner, JSG; Rachlis, A; Tsoukas, C; Hogg, RS; Lima, VD
• Other Names: Hogg Robert investigator.; Kelly Deborah investigator.; Sanche Stephen investigator.; Wong Alexander investigator.; Antoniou Tony investigator.; Bayoumi Ahmed investigator.; Hull Mark investigator.; Nosyk Bohdan investigator.; Cotterchio Michelle investigator.; Goldsmith Charlie investigator.; Guillemi Silvia investigator.; Harrigan P. Richard investigator.; Harris Marianne investigator.; Johnston Sharon investigator.; Kendall Claire investigator.; Liddy Clare investigator.; Marsh David investigator.; Moore David investigator.; Palmer Alexis investigator.; Patterson Sophie investigator.; Phillips Peter investigator.; Rachlis Anita investigator.; Rourke Sean B. investigator.; Samji Hasina investigator.; Smieja Marek investigator.; Trottier Benoit investigator.; Wainberg Mark investigator.; Walmsley Sharon investigator.; Archibald Chris investigator.; Clement Ken investigator.; Crouzat Fred investigator.; Doolittle‐Romas Monique investigator.; Edmiston Laurie investigator.; Gardner Sandra investigator.; Huskins Brian investigator.; Lee Douglas investigator.; Masching Renee investigator.; Tattle Stephen investigator.; Zahirieh Alireza investigator.; Calvez Stryker investigator.; Chia Jason investigator.; Corsi Daniel investigator.; Gilbert Louise investigator.; Gataric Nada investigator.; Light Lucia investigator.; Mackie David investigator.; Merritt Katelyn investigator.; Pexos Costas investigator.; Shurgold Susan investigator.; Szadkowski Leah investigator.; Galanakis Chrissi investigator.; Sandler Ina investigator.; Yip Benita investigator.; Younger Jaime investigator.; Zhu Julia investigator.;
• Is Part Of: HIV medicine. Volume 18:Issue 3(2017:Mar.)
• Page Start: 151
• Page End: 160
• Publication Date: 2016-07-06
• Subjects: antiretroviral therapy -- Canada -- HIV -- mortality -- quality of care -- treatment guidelines.; HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12409
• Languages: English
• ISSNs: 1464-2662

Abstract

Abstract : Objectives: To document the quality of initial HIV care in Canada using the Programmatic Compliance Score (PCS), to explore the association of the PCS with mortality, and to identify factors associated with higher quality of care. Methods: We analysed data from the Canadian Observational Cohort Collaboration (CANOC), a multisite Canadian cohort of HIV‐positive adults initiating combination antiretroviral therapy (ART) from 2000 to 2011. PCS indicators of noncompliance with HIV treatment guidelines include: fewer than three CD4 count tests in the first year of ART; fewer than three viral load tests in the first year of ART; no drug resistance testing before initiation; baseline CD4 count < 200 cells/mm 3 ; starting a nonrecommended ART regimen; and not achieving viral suppression within 6 months of initiation. Indicators are summed for a score from 0 to 6; higher scores indicate poorer care. Cox regression was used to assess the association between PCS and mortality and ordinal logistic regression was used to explore factors associated with higher quality of care. Results: Of the 7460 participants (18% female), the median score was 1.0 (Q1−Q3 1.0−2.0); 21% scored 0 and 8% scored ≥ 4. In multivariable analysis, compared with a score of 0, poorer PCS was associated with mortality for scores > 1 [score = 2: adjusted hazard ratio (AHR) 1.64; 95% confidence interval (CI) 1.13–2.36; score = 3: AHR 2.02; 95% CI 1.38–2.97; score ≥ 4: AHR 2.14; 95% CI 1.43–3.21], after adjustments for age, sex, province, ART start year, hepatitis C virus (HCV) coinfection, and baseline viral load. Women, individuals with HCV coinfection, younger people, and individuals starting ART earlier (2000−2003) had poorer scores. Conclusions: Our findings further validate the PCS as a predictor of all‐cause mortality. Disparities identified suggest that further efforts are needed to ensure that care is equitably accessible.