The impact of routine HIV drug resistance testing in Ontario: A controlled interrupted time series study

PLoS One. 2021 Apr 2;16(4):e0246766. doi: 10.1371/journal.pone.0246766. eCollection 2021.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Interpretation: The policy of routine resistance testing within three months of diagnosis is beneficial at the population level.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / pharmacology
  • Anti-HIV Agents / therapeutic use*
  • Drug Resistance, Viral*
  • Female
  • HIV / drug effects
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • Hospitalization
  • Humans
  • Interrupted Time Series Analysis
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Young Adult

Substances

  • Anti-HIV Agents

Grants and funding

This work was supported by The Ontario HIV Treatment Network (OHTN) grant number EFP-1096-Junior Inv. This study was supported by an award from Constantine Douketis New Researcher Award of The Research Institute of St. Joe’s Hamilton. The study's analysis was supported by the Institute for Clinical Evaluative Sciences (ICES). Parts of this material are based on data and information compiled and provided by the MOHLTC CIHI and PHO. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.