Cohort Profile: Seek and Treat for the Optimal Prevention of HIV/AIDS in British Columbia (STOP HIV/AIDS BC)

Heath, Katherine; Samji, Hasina; Nosyk, Bohdan; Colley, Guillaume; Gilbert, Mark; Hogg, Robert S.; Montaner, Julio S. G.

doi:10.1093/ije/dyu070

Cited by 57 publications

(57 citation statements)

References 17 publications

(18 reference statements)

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“…Details regarding the construction and composition of the HIV-positive cohort and available databases are provided elsewhere. 16 To inform changes in the frequency of injection, and the probability of needle sharing, we used publicly-available records of the number of needles dispensed 17 (available from 2006–2013) and the number of person-years on OAT 18 (available from 2001–2013) (Table A4 and A5 in the appendix, page 10). The study was approved by the University of British Columbia/Providence Health Care’s research ethics board.…”

Section: Methodsmentioning

confidence: 99%

Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996–2013: a modelling study

et al. 2017

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Summary Background Antiretroviral therapy (ART) and harm reduction services have been cited as key contributors to the control of the HIV epidemic, however the specific contribution of the latter has been questioned due to uncertainty in the true efficacy of ART on HIV transmission through needle sharing. Using provincial data on OAT uptake and needle distribution volumes, we aimed to isolate the independent effects of harm reduction services and ART on HIV transmission via needle sharing in British Columbia, from 1996–2013. Methods Using comprehensive linked population-level data, we populated a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in BC from 1996–2013. HIV incidence, mortality, and quality-adjusted life years (QALYs) were estimated. We estimated scenarios designed to isolate the independent effects of harm reduction services and ART (assuming 50% (10%–90%) efficacy) in reducing HIV incidence through needle sharing. Structural and parameter uncertainty was investigated. Findings We estimated that 3204 (2402–4589) incident HIV cases were averted between 1996 and 2013 as a result of the combined effect of the expansion of harm reduction services and ART coverage on HIV transmission via needle sharing. In a hypothetical scenario assuming ART had zero effect on transmission through needle sharing, we estimated harm reduction services alone would have accounted for 77% (62%–95%) of averted HIV incidence. In a separate hypothetical scenario where harm reduction services remained at 1996 levels, we estimated ART alone would have accounted for 44% (10%–67%) of averted HIV incidence. Due to high distribution volumes, needle distribution predominantly accounted for incidence reductions attributable to harm reduction, however OAT provided substantially greater QALY gains. Interpretation If the true efficacy of ART in preventing HIV transmission through needle sharing is closer to its efficacy in sexual transmission, ART’s impact on incident cases averted may be greater than that of harm reduction. Nonetheless, harm reduction services played a vital role in reducing HIV incidence in BC, and should be viewed as critical and cost-effective tools in combination implementation strategies to reduce the public health and economic burden of HIV/AIDS.

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Section: Methodsmentioning

confidence: 99%

Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996–2013: a modelling study

et al. 2017

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“…These types of cascades are commonly constructed from longitudinal clinical record systems, in which stage status is continuously updated over time [24 && , [29][30][31][32], although at least one cascade study utilizes a single survey to elicit the data on the achievement of all cascade stages for each individual who is interviewed [33]. Using a single denominator throughout the cascade has the key advantage of very high internal consistency, and will generally decrease the risk of misleading inference regarding the ease or difficulty of reaching particular cascade stages.…”

Section: Denominator-denominator Linkagementioning

confidence: 99%

Constructing the cascade of HIV care

Haber

Pillay

Porter

et al. 2016

Current Opinion in HIV and AIDS

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“…Details regarding the construction of the population-level cohort and available databases have previously been described [30]. …”

Section: Methodsmentioning

confidence: 99%

Characterizing retention in HAART as a recurrent event process

Nosyk

Lourenço

Min

et al. 2015

Aids

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Objective The benefits of HAART rely on continuous lifelong treatment retention. We used linked population-level health administrative data to characterize durations of HAART retention and nonretention. Design This is a retrospective cohort study. Methods We considered individuals initiating HAART in British Columbia (1996–2012). An HAART episode was considered discontinued if individuals had a gap of at least 30 days between days in which medication was prescribed. We considered durations of HAART retention and nonretention separately, and used Cox proportional hazards frailty models to identify demographic and treatment-related factors associated with durations of HAART retention and nonretention. Results Six thousand one hundred fifty-two individuals were included in the analysis; 81.2% were male, 40.6% were people who inject drugs, and 42.8% initiated treatment with CD4 cell count less than 200 cells/μl. Overall, 29% were continuously retained on HAART through the end of follow-up. HAART episodes were a median 6.8 months (25th, 75th percentile: 2.3, 19.5), whereas off-HAART episodes lasted a median 1.9 months (1.2, 4.5). In Cox proportional hazards frailty models, durations of HAART retention improved over time. Successive treatment episodes tended to decrease in duration among those with multiple attempts, whereas off-HAART episodes remained relatively stable. Younger age, earlier stages of disease progression, and injection drug use were all associated with shorter durations of HAART retention and longer off-HAART durations. Conclusion Metrics to monitor HAART retention, dropout, and reentry should be prioritized for HIV surveillance. Clinical strategies and public health policies are urgently needed to improve HAART retention, particularly among those at earlier stages of disease progression, the young, and people who inject drugs.

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Cohort Profile: Seek and Treat for the Optimal Prevention of HIV/AIDS in British Columbia (STOP HIV/AIDS BC)

Cited by 57 publications

References 17 publications

Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996–2013: a modelling study

Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996–2013: a modelling study

Constructing the cascade of HIV care

Characterizing retention in HAART as a recurrent event process

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