A Two-Stage Approach for Rapid Assessment of the Proportion Achieving Viral Suppression Using Routine Clinical Data

Citation

Edwards, Jessie K.; Donastorg, Yeycy A.; Zadrozny, Sabrina; Hileman, Sarah Bassett; Gómez, Hoisex; Seamans, Marissa J.; Herce, Michael E.; Ramírez, Edwin; Barrington, Clare; & Weir, Sharon S. (2022). A Two-Stage Approach for Rapid Assessment of the Proportion Achieving Viral Suppression Using Routine Clinical Data. Epidemiology, 33(5), 642-649. PMCID: PMC9378579

Abstract

BACKGROUND: Improving viral suppression among people with HIV reduces morbidity, mortality, and transmission. Accordingly, monitoring the proportion of patients with a suppressed viral load is important to optimizing HIV care and treatment programs. But viral load data are often incomplete in clinical records. We illustrate a two-stage approach to estimate the proportion of treated people with HIV who have a suppressed viral load in the Dominican Republic.
METHODS: Routinely collected data on viral load and patient characteristics were recorded in a national database, but 74% of patients on treatment at the time of the study did not have recent viral load measurement. We recruited a subset of these patients for a rapid assessment that obtained additional viral load measurements. We combined results from the rapid assessment and main database using a two-stage weighting approach and compared results to estimates obtained using standard approaches to account for missing data.
RESULTS: Of patients with recent routinely collected viral load data, 60% had a suppressed viral load. Results were similar after applying standard approaches to account for missing data. Using the two-stage approach, we estimated that 77% (95% CI: 74, 80) of those on treatment had a suppressed viral load.
CONCLUSIONS: When assessing the proportion of people on treatment with a suppressed viral load using routinely collected data, applying standard approaches to handle missing data may be inadequate. In these settings, augmenting routinely collected data with data collected through sampling-based approaches could allow more accurate and efficient monitoring of HIV treatment program effectiveness.

URL

http://dx.doi.org/10.1097/ede.0000000000001513

Reference Type

Journal Article

Year Published

2022

Journal Title

Epidemiology

Author(s)

Edwards, Jessie K.
Donastorg, Yeycy A.
Zadrozny, Sabrina
Hileman, Sarah Bassett
Gómez, Hoisex
Seamans, Marissa J.
Herce, Michael E.
Ramírez, Edwin
Barrington, Clare
Weir, Sharon S.

Article Type

Regular

PMCID

PMC9378579

Continent/Country

Dominican Republic

ORCiD

Barrington - 0000-0001-7802-4051
Edwards, J -0000-0002-1741-335X