From the Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Instituto Dermatológico y Cirugia de Piel, Santo Domingo, Dominican Republic.
Epidemiology. 2022 Sep 1;33(5):642-649. doi: 10.1097/EDE.0000000000001513. Epub 2022 May 30.
Improving viral suppression among people with HIV reduces morbidity, mortality, and transmission. Accordingly, monitoring the proportion of patients with a suppressed viral load is important to optimizing HIV care and treatment programs. But viral load data are often incomplete in clinical records. We illustrate a two-stage approach to estimate the proportion of treated people with HIV who have a suppressed viral load in the Dominican Republic.
Routinely collected data on viral load and patient characteristics were recorded in a national database, but 74% of patients on treatment at the time of the study did not have a recent viral load measurement. We recruited a subset of these patients for a rapid assessment that obtained additional viral load measurements. We combined results from the rapid assessment and main database using a two-stage weighting approach and compared results to estimates obtained using standard approaches to account for missing data.
Of patients with recent routinely collected viral load data, 60% had a suppressed viral load. Results were similar after applying standard approaches to account for missing data. Using the two-stage approach, we estimated that 77% (95% confidence interval [CI] = 74, 80) of those on treatment had a suppressed viral load.
When assessing the proportion of people on treatment with a suppressed viral load using routinely collected data, applying standard approaches to handle missing data may be inadequate. In these settings, augmenting routinely collected data with data collected through sampling-based approaches could allow more accurate and efficient monitoring of HIV treatment program effectiveness.
提高艾滋病毒感染者的病毒抑制率可降低发病率、死亡率和传播率。因此，监测病毒载量得到抑制的患者比例对于优化艾滋病毒护理和治疗方案非常重要。但是，临床记录中的病毒载量数据通常不完整。我们介绍了一种两阶段方法，用于估计多米尼加共和国接受治疗的艾滋病毒感染者中病毒载量得到抑制的比例。
常规收集的病毒载量和患者特征数据记录在国家数据库中，但在研究时，74%接受治疗的患者最近没有进行病毒载量测量。我们招募了这些患者的一部分进行快速评估，以获得额外的病毒载量测量结果。我们使用两阶段加权方法将快速评估和主要数据库的结果结合起来，并将结果与用于处理缺失数据的标准方法获得的估计值进行比较。
在最近有常规收集的病毒载量数据的患者中，有 60%的患者病毒载量得到抑制。在应用标准方法处理缺失数据后，结果相似。使用两阶段方法，我们估计治疗中的 77%（95%置信区间[CI] = 74, 80）患者病毒载量得到抑制。
在使用常规收集的数据评估治疗中病毒载量得到抑制的患者比例时，应用标准方法处理缺失数据可能不够充分。在这些情况下，通过基于抽样的方法收集数据来补充常规收集的数据，可以更准确和高效地监测艾滋病毒治疗计划的效果。
