Public Health Ontario, Toronto, Ontario, Canada.
Ontario HIV Treatment Network, Toronto, Ontario, Canada.
BMJ Open. 2019 May 27;9(5):e027325. doi: 10.1136/bmjopen-2018-027325.
Population-based cohorts of diagnosed people living with HIV (PLWH) are limited worldwide. In Ontario, linked HIV diagnostic and viral load (VL) test databases are centralised and contain laboratory data commonly used to measure engagement in HIV care. We used these linked databases to create a population-based, retrospective cohort of diagnosed PLWH in Ontario, Canada.
A datamart was created by integrating diagnostic and VL databases and linking records at the individual level. These databases contain information on laboratory test results and sociodemographic/clinical information collected on requisition/surveillance forms. Datamart individuals enter our cohort with the first record of a nominal HIV-positive diagnostic test (1985-2015) or VL test (1996-2015), and remain unless administratively lost to follow-up (LTFU; no VL test for >2 years and no VL test in later years). Non-nominal diagnostic tests are excluded as they lack identifying information to permit linkage to other tests. However, individuals diagnosed non-nominally are included in the cohort with record of a VL test. The LTFU rule is applied to indirectly censor for death/out-migration.
As of the end of 2015, the datamart contained 40 372 HIV-positive diagnostic tests and 23 851 individuals with ≥1 VL test. Almost half (46.3%) of the diagnostic tests were non-nominal and excluded, although this was lower (~15%) in recent years. Overall, 29 587 individuals have entered the cohort-contributing 229 302 person-years of follow-up since 1996. Between 2000 and 2015, the number of diagnosed PLWH (cohort individuals not LTFU) increased from 8859 to 16 110, and the percent who were aged ≥45 years increased from 29.1% to 62.6%. The percent of diagnosed PLWH who were virally suppressed (<200 copies/mL) increased from 40.7% in 2000 to 79.5% in 2015.
We plan to conduct further analyses of HIV care engagement and link to administrative databases with information on death, migration, physician billing claims and prescriptions. Linkage to other data sources will address cohort limitations and expand research opportunities.
全球范围内，基于人群的确诊 HIV 感染者（PLWH）队列研究较为有限。在安大略省，HIV 诊断和病毒载量（VL）检测数据库集中且包含用于评估 HIV 护理参与度的实验室数据。我们利用这些数据库建立了一个基于人群的、回顾性的安大略省确诊 PLWH 队列。
通过整合诊断和 VL 数据库并以个体水平进行记录链接，创建了一个数据集市。这些数据库包含实验室检测结果以及通过申请/监测表收集的社会人口学/临床信息。个体进入数据集市的标准为首次记录到名义 HIV 阳性诊断检测（1985-2015 年）或 VL 检测（1996-2015 年），除非因管理原因失访（LTFU；超过 2 年未进行 VL 检测且随后年份未进行 VL 检测）。排除非名义诊断检测，因为它们缺乏识别信息，无法与其他检测进行链接。然而，有 VL 检测记录的非名义诊断感染者也被纳入队列。LTFU 规则用于间接剔除死亡/外迁。
截至 2015 年底，数据集市包含 40372 次 HIV 阳性诊断检测和 23851 名至少有 1 次 VL 检测的个体。近一半（46.3%）的诊断检测是非名义的，被排除在外，尽管最近几年这一比例（约 15%）有所下降。总体而言，自 1996 年以来，有 29587 人进入队列，贡献了 229302 人年的随访。2000 年至 2015 年期间，确诊 PLWH（非 LTFU 的队列个体）的数量从 8859 人增加到 16110 人，年龄≥45 岁的比例从 29.1%增加到 62.6%。病毒载量抑制（<200 拷贝/毫升）的确诊 PLWH 的比例从 2000 年的 40.7%增加到 2015 年的 79.5%。
我们计划进一步分析 HIV 护理参与度，并与包含死亡、迁移、医生计费和处方信息的行政数据库进行链接。与其他数据源的链接将解决队列的局限性并扩大研究机会。
