The Ontario HIV Treatment Network, Toronto, 1300 Yonge Street, Toronto, Ontario, M4T 1X3, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Can J Public Health. 2018 Dec;109(5-6):800-809. doi: 10.17269/s41997-018-0104-z. Epub 2018 Aug 23.
We investigated the effect of drug coverage on viral suppression (sVL) in Ontario, Canada, where there is no universal coverage of prescription drugs, including antiretroviral therapy (ART).
Ontarians without employment coverage may be eligible for varying degrees of coverage through government-sponsored programs. Remaining individuals pay all expenses entirely out of pocket. Among participants on ART enrolled in the Ontario HIV Treatment Network Cohort Study (OCS) who were interviewed in 2008-2013 with known or imputable drug coverage, we estimated the prevalence with sVL (< 200 copies/mL) as of their last viral load each year. We calculated prevalence ratios (PR) according to time-updated socio-economic and behavioural factors using multivariable generalized estimating equations with a log-link function. Multiple imputation was used to assess the sensitivity of these findings to different assumed missing data models.
One thousand two hundred forty-seven participants were included (3463 person-years). Compared to study participants with employer coverage, individuals covered through the Ontario Drug Benefit (ODB) were less likely to be suppressed (PR, 95% confidence interval (CI) 0.96, 0.93-0.98). After multivariable adjustment, ODB remained independently associated with less success in achieving sVL (adjusted PR, 95% CI 0.98, 0.95-0.99). These findings were robust to different assumptions about the missing data.
Our findings suggest that drug coverage can affect viral suppression in our setting. Further research is needed to identify the mechanisms by which coverage interacts with individual patient factors to affect viral suppression. Mechanisms to improve access and coverage for ART are needed.
我们研究了加拿大安大略省药物覆盖范围对病毒抑制（sVL）的影响，该省没有包括抗逆转录病毒疗法（ART）在内的处方药普遍覆盖。
没有就业保险的安大略省居民可能有资格通过政府资助的计划获得不同程度的保险。其余的人则完全自费支付所有费用。在参加安大略省艾滋病毒治疗网络队列研究（OCS）的接受 ART 的参与者中，对于 2008-2013 年接受访谈且已知或可推断药物覆盖范围的参与者，我们根据每年最后一次病毒载量的时间更新社会经济和行为因素，估计具有 sVL（<200 拷贝/ml）的患病率。我们使用具有对数链接函数的多变量广义估计方程，根据时间更新的社会经济和行为因素计算患病率比（PR）。使用多重插补来评估这些发现对不同假定缺失数据模型的敏感性。
共纳入 1247 名参与者（3463 人年）。与有雇主保险的研究参与者相比，通过安大略省药物福利（ODB）覆盖的个体被抑制的可能性较小（PR，95%置信区间（CI）0.96，0.93-0.98）。在多变量调整后，ODB 仍然与实现 sVL 的成功率较低独立相关（调整后的 PR，95%CI 0.98，0.95-0.99）。这些发现对于缺失数据的不同假设都是稳健的。
我们的研究结果表明，药物覆盖范围可能会影响我们研究环境中的病毒抑制。需要进一步研究以确定覆盖范围如何与个体患者因素相互作用影响病毒抑制的机制。需要采取措施来改善对 ART 的获得和覆盖。
