title: Development and validation of a composite programmatic assessment tool for HIV therapy.
abstract: BACKGROUND
  We developed and validated a new and simple metric, the Programmatic Compliance Score (PCS), based on the IAS-USA antiretroviral therapy management guidelines for HIV-infected adults, as a predictor of all-cause mortality, at a program-wide level. We hypothesized that non-compliance would be associated with the highest probability of mortality.
  
  
  RESULTS
  3543 antiretroviral-naive HIV-infected patients aged ≥19 years who initiated antiretroviral therapy between January 1, 2000 and August 31, 2009 in British Columbia (BC), Canada, were followed until August 31, 2010. The PCS is composed by six non-performance indicators based on the IAS-USA guidelines: (1) having <3 CD4 count tests in the first year after starting antiretroviral therapy; (2) having <3 plasma viral load tests in the first year after starting antiretroviral therapy; (3) not having drug resistance testing done prior to starting antiretroviral therapy; (4) starting on a non-recommended antiretroviral therapy regimen; (5) starting therapy with CD4 <200 cells/mm(3); and (6) not achieving viral suppression within 6 months since antiretroviral therapy initiation. The sum of these six indicators was used to develop the PCS score - higher score indicates poorer performance. The main outcome was all-cause mortality. Each PCS component was independently associated with mortality. In the mortality analysis, the odds ratio (OR) for PCS ≥4 versus 0 was 22.37 (95% CI 10.46-47.84).
  
  
  CONCLUSIONS
  PCS was strongly associated with all-cause mortality. These results lend independent validation to the IAS-USA treatment guidelines for HIV-infected adults. Further efforts are warranted to enhance the PCS as a means to further improve clinical outcomes. These should be specifically evaluated and targeted at healthcare providers and patients.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada. vlima@cfenet.ubc.ca
authors.forename: Viviane D
authors.initials: VD
authors.lastname: Lima
authors.forename: Adrian
authors.initials: A
authors.lastname: Le
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.forename: Rolando
authors.initials: R
authors.lastname: Barrios
authors.forename: Benita
authors.initials: B
authors.lastname: Yip
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: P Richard
authors.initials: PR
authors.lastname: Harrigan
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010349:Patient Compliance; D011336:Probability; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity