Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada.
PLoS One. 2021 Apr 2;16(4):e0246766. doi: 10.1371/journal.pone.0246766. eCollection 2021.
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.
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.
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.
The policy of routine resistance testing within three months of diagnosis is beneficial at the population level.
对 HIV 耐药性的了解可以为方案选择提供信息，并确保选择最有效的方案。2014 年 1 月，加拿大安大略省实施了一项常规耐药检测政策变更。本研究的目的是调查自 2014 年 1 月以来，加拿大安大略省常规耐药检测对 HIV 感染者政策变更的影响。
我们使用安大略省艾滋病毒感染者的临床评估科学研究所（ICES）和安大略省公共卫生署（PHO）的行政数据库中的数据，对 2005 年至 2013 年（政策变更前）和 2014 年至 2017 年（政策变更后）的两年死亡率、两年住院率和两年急诊就诊率进行了普通最小二乘法（OLS）模型的中断时间序列分析。结果以每两年一次的时间间隔收集，干预前有 18 个时间间隔，干预后有 8 个时间间隔。我们还包括了一组未在 HIV 诊断后 3 个月内接受耐药性检测的对照人群。
数据包括 12996 名艾滋病毒感染者，其中 8881 名（68.3%）在 2005 年至 2013 年期间被诊断，4115 名（31.7%）在 2014 年至 2017 年期间被诊断。在 HIV 诊断后 3 个月内进行常规耐药检测的政策变化导致每六个月 2 年死亡率下降 0.8%，与对照组相比呈下降趋势。住院或急诊就诊率没有显著差异。
在诊断后三个月内进行常规耐药检测的政策对人群水平有益。
