The relationship between antiretroviral prescription patterns and treatment guidelines in treatment‐naïve HIV‐1‐infected patients

Abstract

Reports have shown that the publication of practice guidelines does not guarantee their use in clinical practice. The objective of this study was to evaluate the agreement between antiretroviral treatments (ARTs) prescribed in clinical practice and the recommendations in published guidelines. ResultsA total of 945 patients initiated ART. Of these patients, 12.3% had a CD4 cell count above 350 cells/mL. A 'nonrecommended' antiretroviral regimen was prescribed to 5.3, 5.1 and 7.8% of patients with CD4 counts o200, 200-350 and 4350 cells/mL, respectively. Multivariate analyses demonstrated that only a higher viral load was associated with the selection of a combination treatment that was recommended by the guidelines. ConclusionsMost patients were prescribed initial treatments in agreement with the recommendations. Appropriate routine data collection in databases can be used to evaluate the level of antiretroviral guideline compliance. We propose that routine evaluations of the guidelines must be part of quality assessment to improve medical care. IntroductionThe use of clinical practice guidelines (CPG) to orientate medical decision making is becoming increasingly common for many diseases [1]. In Spain, both the National Plan against AIDS and the AIDS Study Group of the Spanish The influence that antiretroviral treatment (ART) recommendations have on antiretroviral combination therapy in clinical practice has been poorly studied. Although there are studies on temporal trends in antiretroviral drug use, few studies have analysed the relationship between prescriptions and CPG. The little information available on the subject consists of data from different sources, including audits performed in individual hospitals [6][7][8], periodical reports from the British HIV Association [9], and a few cohort studies [10][11][12]. In the present study we evaluate the degree of agreement between initial ART prescriptions and Spanish CPG recommendations. Additionally, we ascertain the feasibility of using clinical databases as a source of information for treatment audits. MethodsThe Asociacion Medica Vach de Estudios Multicentricos (VACH) Cohort recruits patients from 19 hospitals belonging to the Spanish National Health Service, which are located in 15 different cities and nine autonomous communities. The VACH sites cover approximately 15% of the total Spanish population. Nearly 14 000 patients, aged 16 years or older, were included in the cohort at the time of the study. Their personal and clinical data were recorded in a common computer database (ACyH s , Betek 43 SL, Huelva, Spain). Laboratory tests, including measurements of the CD4 cell count and viral load, were performed every 4-6 months and results recorded in the database. AIDS cases were identified using the current European criteria [13].An extensive description of the inclusion criteria, methodology, and patients' characteristics has been published previously [14,15]. Patients were asked to sign an informed consent form prior to inclusion in the cohort. Personal da...

Compliance with national guidelines for HIV treatment and its association with mortality and treatment outcome: a study in a Spanish cohort

“…We found that the choice of initial antiretroviral regimen was appropriate in most cases: 91.5% of patients started treatment that was considered recommended or alternative by the guidelines. This is consistent with a study in the Spanish Asociación Médica Vach de Estudios Multicéntricos (VACH) cohort in the years 2004–2006, which found that initial treatment regimens were compliant with the guidelines in 95% of cases . Similar proportions have been found in other European studies , but studies from the USA have found lower percentages of compliance .…”

“…Guidelines for the treatment of HIV infection are available in many countries [3][4][5]; however, there is little evidence assessing compliance with clinical practice guidelines for antiretroviral treatment and its impact on clinical outcomes. Among the few studies that have investigated this issue [6][7][8][9][10][11][12][13][14][15][16][17], only two [7,13] evaluated the relationship of adherence to treatment guidelines with immunovirological outcome. Most importantly, none of these studies has evaluated its relationship with mortality.…”

Modeling the dissemination and uptake of clinical trials results

“…Furthermore, previous research of HIV/AIDS clinical trials results showed differences in how quickly trials were completed and subsequently published, affecting the availability of evidence to the broader scientific community (Ioannidis, 1998). Research also shows a strong adherence to the recommendations found in practice guidelines by clinicians for the treatment of HIV/AIDS patients (Suarez-Lozano et al, 2009; Petersen et al, 2011), emphasizing the importance of the use of secondary research outputs in the field. These prior studies suggest the need to operationalize patterns of recognition over time as a way to more precisely assess the movement from clinical trial results to changes in clinical practice.…”

Adoption of new HIV treatment guidelines and drug substitutions within first‐line as a measure of quality of care in rural Lesotho: health centers and hospitals compared

“…Publication of practice guidelines does not guarantee their use in clinical practice. Routine evaluation of adherence to guidelines has thus been recommended as a measure of quality of care (Suarez-Lozano et al 2009). In several low-income countries guidelines are changing or have changed already.…”