Quality of initial HIV care in Canada: extension of a composite programmatic assessment tool for HIV therapy

S Kesselring; A Cescon; G Colley; C Osborne; W Zhang; J M Raboud; S R Hosein; A N Burchell; C Cooper; M B Klein; M Loutfy; N Machouf; Jsg Montaner; A Rachlis; C Tsoukas; R S Hogg; V D Lima; Canadian Observational Cohort Collaboration (CANOC)

doi:10.1111/hiv.12409

Quality of initial HIV care in Canada: extension of a composite programmatic assessment tool for HIV therapy

HIV Med. 2017 Mar;18(3):151-160. doi: 10.1111/hiv.12409. Epub 2016 Jul 6.

Authors

S Kesselring¹, A Cescon², G Colley¹, C Osborne¹, W Zhang¹, J M Raboud^{3

4}, S R Hosein⁵, A N Burchell^{4

6}, C Cooper⁷, M B Klein⁸, M Loutfy^{4

9

10}, N Machouf¹¹, Jsg Montaner^{1

12}, A Rachlis¹³, C Tsoukas⁸, R S Hogg^{1

14}, V D Lima^{1

12}; Canadian Observational Cohort Collaboration (CANOC)

Collaborators

Canadian Observational Cohort Collaboration (CANOC):
Robert Hogg, Deborah Kelly, Stephen Sanche, Alexander Wong, Tony Antoniou, Ahmed Bayoumi, Mark Hull, Bohdan Nosyk, Michelle Cotterchio, Charlie Goldsmith, Silvia Guillemi, P Richard Harrigan, Marianne Harris, Sharon Johnston, Claire Kendall, Clare Liddy, David Marsh, David Moore, Alexis Palmer, Sophie Patterson, Peter Phillips, Anita Rachlis, Sean B Rourke, Hasina Samji, Marek Smieja, Benoit Trottier, Mark Wainberg, Sharon Walmsley, Chris Archibald, Ken Clement, Fred Crouzat, Monique Doolittle-Romas, Laurie Edmiston, Sandra Gardner, Brian Huskins, Douglas Lee, Renee Masching, Stephen Tattle, Alireza Zahirieh, Stryker Calvez, Jason Chia, Daniel Corsi, Louise Gilbert, Nada Gataric, Lucia Light, David Mackie, Katelyn Merritt, Costas Pexos, Susan Shurgold, Leah Szadkowski, Chrissi Galanakis, Ina Sandler, Benita Yip, Jaime Younger, Julia Zhu

Affiliations

¹ British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
² Northern Ontario School of Medicine, Sudbury, ON, Canada.
³ Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
⁴ University of Toronto, Toronto, ON, Canada.
⁵ CATIE, Toronto, ON, Canada.
⁶ Ontario HIV Treatment Network, Toronto, ON, Canada.
⁷ University of Ottawa, Ottawa, ON, Canada.
⁸ McGill University, Montreal, QC, Canada.
⁹ Women's College Research Institute, Toronto, ON, Canada.
¹⁰ Maple Leaf Medical Clinic, Toronto, ON, Canada.
¹¹ Clinique médicale l'Actuel, Montreal, QC, Canada.
¹² University of British Columbia, Vancouver, BC, Canada.
¹³ Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁴ Simon Fraser University, Burnaby, BC, Canada.

PMID: 27385643
DOI: 10.1111/hiv.12409

Abstract

Objectives: To document the quality of initial HIV care in Canada using the Programmatic Compliance Score (PCS), to explore the association of the PCS with mortality, and to identify factors associated with higher quality of care.

Methods: We analysed data from the Canadian Observational Cohort Collaboration (CANOC), a multisite Canadian cohort of HIV-positive adults initiating combination antiretroviral therapy (ART) from 2000 to 2011. PCS indicators of noncompliance with HIV treatment guidelines include: fewer than three CD4 count tests in the first year of ART; fewer than three viral load tests in the first year of ART; no drug resistance testing before initiation; baseline CD4 count < 200 cells/mm³ ; starting a nonrecommended ART regimen; and not achieving viral suppression within 6 months of initiation. Indicators are summed for a score from 0 to 6; higher scores indicate poorer care. Cox regression was used to assess the association between PCS and mortality and ordinal logistic regression was used to explore factors associated with higher quality of care.

Results: Of the 7460 participants (18% female), the median score was 1.0 (Q1-Q3 1.0-2.0); 21% scored 0 and 8% scored ≥ 4. In multivariable analysis, compared with a score of 0, poorer PCS was associated with mortality for scores > 1 [score = 2: adjusted hazard ratio (AHR) 1.64; 95% confidence interval (CI) 1.13-2.36; score = 3: AHR 2.02; 95% CI 1.38-2.97; score ≥ 4: AHR 2.14; 95% CI 1.43-3.21], after adjustments for age, sex, province, ART start year, hepatitis C virus (HCV) coinfection, and baseline viral load. Women, individuals with HCV coinfection, younger people, and individuals starting ART earlier (2000-2003) had poorer scores.

Conclusions: Our findings further validate the PCS as a predictor of all-cause mortality. Disparities identified suggest that further efforts are needed to ensure that care is equitably accessible.

Keywords: HIV; Canada; antiretroviral therapy; mortality; quality of care; treatment guidelines..

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Canada
HIV Infections / diagnosis*
HIV Infections / drug therapy*
HIV Infections / mortality
Health Services Research*
Quality of Health Care*

Grants and funding

CIHR/Canada