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Objectives  A measure used for assessing the effectiveness of  HIV  care and comparing clinical centres is the proportion of people starting antiretroviral therapy ( ART ) with viral suppression ( VS ) after 1 year. We propose a method that adjusts for patients’ demographic characteristics, and visually compares this measure between different sites accounting for centre size.    Methods  We analysed viral load measurements for  UK  Collaborative  HIV  Cohort ( UK CHIC ) patients starting  ART  between 2006 and 2013. We used logistic regression to estimate the proportion with  VS  after 1 year of  ART  adjusted for patient mix (in terms of age and a combined gender/ethnicity/acquisition mode variable) and calendar year. We compared outcomes between centres using funnel plots which account for centre size.    Results  The overall proportion of the cohort with  VS  1 year after starting  ART  was 90% and increased from 83% to 93% between 2006 and 2013.  VS  was lower in younger individuals. White men who have sex with men ( MSM ) had the highest (94%), and black African (81%) and white (82%) heterosexual women the lowest proportions achieving  VS . Comparing the unadjusted funnel plot with the adjusted, there were movements of some centres from outside to inside the 95% contour limits, which was largely explained by the patient mix of these centres.    Conclusions   VS  1 year after  ART  start was associated with demographic characteristics and centre size; therefore, to compare the performances of centres, adjustment for these factors is required. Adjusted funnel plot is an effective tool which accounts for both the demographic characteristics and the centre size. Social factors, rather than treatment decisions within the control of the centres, may drive differences in outcomes.

hiv medicine

The use of funnel plots with regression as a tool to visually compare HIV treatment outcomes between centres adjusting for patient characteristics and size: a UK Collaborative HIV Cohort study