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

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

Lawrence Mbuagbaw  1   2   3 , Carmen H Logie  4   5 , Lehana Thabane  6   7   8 , Fiona Smaill  1 , Marek Smieja  1 , Ann N Burchell  9   10 , Beth Rachlis  11 , Jean-Eric Tarride  1   12 , Abigail Kroch  13 , Tony Mazzulli  14   15   16 , Elizabeth Alvarez  1   17 , Daeria O Lawson  1 , Francis Nguyen  18 , Richard Perez  18 , Hsien Seow  1   19
Affiliations

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

Lawrence Mbuagbaw et al. PLoS One. .

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.

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Conflict of interest statement

Ann N. Burchell is supported by an OHTN Leader Award, Canada Research Chair in Sexually Transmitted Infections and University of Toronto Department of Family and Community Medicine Non-Clinician Scientist Award. Carmen H. Logie is supported by a Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations and the Ontario Ministry of Research & Innovation. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Controlled interrupted time series for two-year mortality.
Fig 2
Fig 2. Controlled interrupted time series for two-year hospitalizations.
Fig 3
Fig 3. Controlled interrupted time series for two-year emergency department visits.
See this image and copyright information in PMC

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