Marseille 2007
Marseille 2007
Abstract book
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Abstract #183  -  Absence of centre effect in HIV treatment: results from the ANRS-EN12-VESPA Study
Session:
  39.8: Treatment (Parallel) on Tuesday @ 14.00-16.00 in HC Chaired by Robin Hamilton, Raffaele Visintini
Authors:
  Presenting Author:   Mr Remi Sitta - INSERM, France
 
  Additional Authors:  Mrs France Lert, Mr Brice Combaud, Mrs Alice Gueguen, Mrs Rosemary Dray-Spira,  
Aim:
It has been shown that in some situations a center effect can exist in HIV treatment. We aimed to measure the heterogeneity of French hospital departments delivering HIV care and test the presence of such an effect on treatment failure as well as on adherence.
 
Method / Issue:
We used data from the ANRS-EN12-VESPA study, a nationally representative two-stage cross-sectional survey conducted in France in 2003. This survey first sampled hospital departments delivering HIV care with a caseload of at least 60 patients, among which HIV-infected outpatients were selected. Data collected included individuals sociodemographic and clinico-biological characteristics in 2003 and retrospective information on their trajectory since HIV diagnosis. Analyses were restricted to the subsample of patients diagnosed after 1996 and on HAART for 6 months or more, which represented 699 participants from 97 sampled hospital departments. Adherence was assessed using a dichotomous indicator validated in previous cohort studies, summarizing four questions dealing with dose-taking during the previous week. Different indicators of treatment failure were defined: immunological failure was defined as the absence of an increase of 100 CD4 cell/l between HAART initiation and the time of data collection. Immunovirological failure was defined as the combination of a CD4 cell count of 200 CD4 cell/l or less and a detectable HIV-RNA viral load at the time of data collection. The center effect was tested by entering hospital departments as a random effect in mixed logistic regressions.
 
Results / Comments:
The hospital departments delivering HIV care proved to be somewhat heterogeneous, as it is shown by their median caseload (400 patients, IQR = [230 750]), their median proportion of migrants (20%, IQR=[0-40%]), or their proportion of: participation in clinical trials (83%), presence on site of associations of people living with HIV/AIDS (PLWHA) (41%), existence of individual adherence sessions (42%) or existence of counselling and treatment for drug users (39%). We measured a proportion of immunovirological failure of 6.1% and of immunological failure of 22.6%, while the observed adherence was 63.3 %. For all of these three outcomes, we observed no center effect. The results remained unchanged when the analysis was restricted to the hospital departments with at least 5 sampled patients, then with at least 10 sampled patients.
 
Discussion:
Despite the heterogeneity of the medical offer among the hospital departments providing HIV care, the therapeutic results are strongly homogeneous on the whole French territory. This conclusion can be attributed to the good application of the therapeutic guidelines, which are regularly updated by consensus.
 
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