Open AccessThe impact of routine HIV drug resistance testing in Ontario: A controlled interrupted time series study
Author(s) -
Lawrence Mbuagbaw,
Carmen H. Logie,
Lehana Thabane,
Fiona Smaill,
Marek Śmieja,
Ann Burchell,
Beth Rachlis,
JeanÉric Tarride,
Abigail Kroch,
Tony Mazzulli,
Elizabeth Álvarez,
Daeria O. Lawson,
Francis Nguyen,
Richard Perez,
Hsien Seow
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0246766
Subject(s) - interrupted time series analysis , interrupted time series , medicine , emergency department , population , public health , drug resistance , human immunodeficiency virus (hiv) , resistance (ecology) , intervention (counseling) , demography , emergency medicine , family medicine , pediatrics , environmental health , psychological intervention , psychiatry , nursing , ecology , statistics , mathematics , sociology , microbiology and biotechnology , biology
Background Knowledge of HIV drug resistance informs the choice of regimens and ensures that the most efficacious options are selected. In January 2014, a policy change to routine resistance testing was implemented in Ontario, Canada. The objective of this study was to investigate the policy change impact of routine resistance testing in people with HIV in Ontario, Canada since January 2014. Methods We used data on people with HIV living in Ontario from administrative databases of the Institute for Clinical Evaluative Sciences (ICES) and Public Health Ontario (PHO), and ran ordinary least squares (OLS) models of interrupted time series to measure the levels and trends of 2-year mortality, 2-year hospitalizations and 2-year emergency department visits before (2005–2013) and after the policy change (2014–2017). Outcomes were collected in biannual periods, generating 18 periods before the intervention and 8 periods after. We included a control series of people who did not receive a resistance test within 3 months of HIV diagnosis. Results Data included 12,996 people with HIV, of which 8881 (68.3%) were diagnosed between 2005 and 2013, and 4115 (31.7%) were diagnosed between 2014 and 2017. Policy change to routine resistance testing within 3 months of HIV diagnosis led to a decreasing trend in 2-year mortality of 0.8% every six months compared to the control group. No significant differences in hospitalizations or emergency department visits were noted. Interpretation The policy of routine resistance testing within three months of diagnosis is beneficial at the population level.