THE USE OF VIRAL LOAD TESTING AND SECOND LINE SWITCHING OF ART TREATMENT IN HAITI

Thesis (Master's)--University of Washington, 2018Objective: To describe time trends in Viral Load (VL) tests and results and time trends in use of second-line antiretroviral regimens for treatment of HIV/AIDS, and eventually to explore the association between VL test and second line regimen switching. Study Design: We conducted a retrospective cohort study with over 80,000 patients drawn from 88 of 160 Haiti's national ART sites. Longitudinal data from the iSanté electronic data system was used to analyze time trends in the routine use of VL testing and switching to second-line ART treatments. We calculated the odds ratio of second-line regimen switching with 95% confidence intervals (CI) comparing patients never tested, patients tested with no VL failure and patients tested with VL failure, adjusted for individual characteristics. Results: The number of viral load tests done annually increased from 11 in 2010 to 20585 in the first nine months of 2017, and the number of second-line regimen switches increased from 21 to 279 in this same period. Comparing patients never tested, patients who had VL testing with virologic suppression had VL tests had a 2.67times higher odds (95% CI for OR: 2.01-3.38; p<0.001) and those with a VL test showing treatment failure had a 6.67 times higher odds (95% CI for OR: 4.09-10.89; p