Abstract
BackgroundKnowledge 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.MethodsWe 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.ResultsData 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.InterpretationThe policy of routine resistance testing within three months of diagnosis is beneficial at the population level.
Highlights
There are approximately 36.9 million people living with HIV worldwide [1]
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)
Policy change to routine resistance testing within 3 months of HIV diagnosis led to a decreasing trend in 2year mortality of 0.8% every six months compared to the control group
Summary
There are approximately 36.9 million people living with HIV worldwide [1]. Antiretroviral therapy (ART) is the mainstay of HIV management and is recommended for everyone with HIV and for people at high risk of HIV infection as a prevention strategy [2]. Drug resistance severely hampers the effectiveness of ART, reduces the number of effective therapeutic options, increases infectiousness, and reduces quality of life and survival [4, 5]. People with TDR are at a higher risk of treatment failure, treatment discontinuation and developing new drug resistant strains [7]. The rise in drug resistance is one of the greatest threats to global health, and can result in millions of deaths, an increase in new harder-to-treat strains of HIV and higher health-care costs [8]. 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
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