From pills to patients: an evaluation of data sources to determine the number of people living with HIV who are receiving antiretroviral therapy in Germany

Schmidt, Daniel; Kollan, Christian; Stoll, Matthias; Stellbrink, Hans‐Jürgen; Plettenberg, Andreas; Fätkenheuer, Gerd; Bergmann, Frank; Bogner, Johannes R.; Lunzen, Jan van; Rockstroh, Jürgen K.; Eßer, Stefan; Jensen, Björn‐Erik Ole; Horst, Heinz‐August; Fritzsche, Carlos; Kühne, Andrea; Heiden, Matthias an der; Hamouda, Osamah; Bartmeyer, Barbara

doi:10.1186/s12889-015-1598-4

Cited by 14 publications

(11 citation statements)

References 26 publications

(22 reference statements)

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“…The standard therapy for HIV during the study period contained exactly one thiacytidine medication (TCM), either lamivudine (3TC) or emtricitabine (FTC). The marker substances for HIV treatment were determined to be 3TC and FTC (Table 1 ) [ 25 , 40 , 41 ]. The determined DDD were 300 mg for 3TC and 200 mg for FTC.…”

Section: Methodsmentioning

confidence: 99%

High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

et al. 2017

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BackgroundIn Germany, medical care of prisoners is completely separated from extramural health care. The extent and quality of medical care among prisoners in Germany are therefore largely unknown. We performed a secondary data analysis of pharmacy sales data for tuberculosis (TB), HIV, hepatitis C (HCV) and opioid substitution treatment (OST) delivered to prisons in 11 federal states (FS) in Germany between 01/2012 and 03/2013. The aims of this study were to assess (i) the treatment availability for the selected diseases and OST in German prisons, (ii) the proportion of prisoners treated per FS and overall for TB, HIV, HCV and OST during the study period.MethodsSubstances unique to or typically used for the treatment of each disease were defined as marker substances with defined daily doses (DDD).For each marker substance we assessed the cumulative number of DDD, the average daily number of DDD (DDDd) and average treatment prevalence per day in percent (adTP). Accordingly, the DDDd represents one person treated per day and the adTP means the proportion of prisoners treated per day. We compared the adTP of the diseases with previously measured prevalences.ResultsWe obtained data from pharmacies supplying prisons in 11 of 16 German FS. Of the included prisons, 41% were supplied with medicines for TB, 71% for HIV and 58% for HCV and OST. Twice as many delivered marker substances for TB were indicated for the continuation phase and chemoprevention than the intensive phase. The HIV adTP ranged from 0.06% to 0.94%, HCV adTP ranged from 0.03% to 0.59% and OST adTP ranged from 0% to 7.90%. The overall adTP for the respective treatment was 0.39% for HIV, 0.12% for HCV and 2.18% for OST.ConclusionsAccording to our findings treatment rates for TB were consistent with the expected TB prevalence, at least in Berlin. HIV treatment seems to be offered to an adequate proportion of estimated infected prisoners. In contrast, the HCV treatment prevalence was low. High variation among FS in provision of all treatments, particularly of OST, point to inconsistent treatment practices, although nationwide extramural treatment guidelines for Germany exist.

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Section: Methodsmentioning

confidence: 99%

High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

et al. 2017

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“…Data on utilization of a particular medication can include medication sales, number of filled prescriptions, or number of written prescriptions. Defined daily dose (DDD) and average treatment time define the amount of the medication needed to treat a patient [22]. Out of the four first-line drugs used in the treatment of TB, Pyrazinamide (PZA) is the only medication used exclusively to treat TB and no other medical conditions and is used primarily in the intense treatment phase.…”

Section: Methodsmentioning

confidence: 99%

Completeness of tuberculosis case notifications in Germany in 2013–2017: first results of an inventory study

et al. 2020

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Background Evaluating the completeness of tuberculosis (TB) notification data is important for monitoring of TB surveillance systems. We conducted an inventory study to calculate TB underreporting in Germany in 2013–2017. Methods Acquisition of two pseudonymized case-based data sources (national TB notification data and antibiotic resistance surveillance data) was followed by two-source Capture-recapture (CRC) analysis, as case-based data from a third source was unavailable. Aggregated data on consumption of a key anti-TB drug (pyrazinamide [PZA]) was compared to an estimated need for PZA based on TB notification data to obtain an independent underreporting estimation. Additionally, notified TB incidence was compared to TB rate in an aggregated health insurance fund dataset. Results CRC and PZA-based approaches indicated that between 93 and 97% (CRC) and between 91 and 95% (PZA) of estimated cases were captured in the national TB notification data in the years 2013–2017. Insurance fund dataset did not indicate TB underreporting on the national level in 2017. Conclusions Our results suggest that more than 90% of estimated TB cases are captured within the German TB surveillance system, and accordingly the TB notification rate is likely a good proxy of the diagnosed TB incidence rate. An increase in underreporting and discrepancies however should be further investigated.

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“…A total of 24,569 people with at least two documented VLs from the ClinSurv HIV and the HIV-1 Seroconverter cohorts were enrolled and followed for a median of 5.9 years (IQR 2. [4][5][6][7][8][9][10][11], totaling 171,990 person-years (PY). The total number of real VL measurements was 570,753, the median number of VL measurements per person was [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], and VL monitoring occurred at a median frequency of every 91 days (IQR 64-112).…”

Section: Study Populationmentioning

confidence: 99%

Everything Counts -- A Method to Determine Viral Suppression Among People Living With Hiv Using Longitudinal Data for the Hiv Care Continuum. - Results of two large, German, multi-center real-life cohort studies over 20 years (1999-2018)

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Kollan

Stoll

et al. 2020

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BackgroundThe aim of this study was to develop a standardized method to reconstruct persons' individual VL courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data.MethodsWe analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1999-2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL values and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was >180 days, the time between was defined as gap time. Additionally, we considered blips, which we defined as a single detectable VL <1,000 copies/ml within 180 days.ResultsA total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL <50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL <200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia >1,000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap time fluctuated and ranged between 18% and 28%. An analysis of the first VL after gap time showed that 90% showed viral suppression, 5% VL between 50-<1,000 copies/ml and 5% VL >1,000 copies/ml.ConclusionWe provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93% and 96% of people after ART initiation showed VL <50 copies/ml and VL <200 copies/ml, respectively. Therefore, using the threshold of VL <200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017.

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From pills to patients: an evaluation of data sources to determine the number of people living with HIV who are receiving antiretroviral therapy in Germany

Cited by 14 publications

References 26 publications

High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

Completeness of tuberculosis case notifications in Germany in 2013–2017: first results of an inventory study

Everything Counts -- A Method to Determine Viral Suppression Among People Living With Hiv Using Longitudinal Data for the Hiv Care Continuum. - Results of two large, German, multi-center real-life cohort studies over 20 years (1999-2018)

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