Description of CD4 and HIV viral load monitoring Tables and Figures (mock-ccasanet-data-2016-12-21) Results are not to be interpreted substantively, but are provided to make our study quasi-reproducible by allowing others to verify the analysis code used for the original report on publicly available simulated data. Yanink Caro & Bryan Shepherd February 13, 2017 1
Figure 1: Estimated mean (and 95% confidence interval) by site for the proportion of 180-day periods with at least one HIV-1 RNA and one CD4 measurement taken per patient. 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Rate of Adequate HIV VL/CD4 Monitoring 2
Figure 2: Estimated mean (and 95% confidence interval) by site for the proportion of 180-day periods with at least one CD4 measurement taken per patient. 0.4 0.5 0.6 0.7 0.8 0.9 Rate of Adequate CD4 Monitoring 3
4 Table 1: Description of Antirretroviral Treatment Programs by Site CMH- FC- FA- GHESKIO- IHSS/HE- INCMNSZ- IMTAvH- Argentina Brazil Chile Haiti Honduras Mexico Peru Number of patients included 1285 2446 1080 5696 789 772 2408 Year of universal access scale-up 2000 1991(a) 2003 2003 2003 2002 2004 Type of clinic ( public, NGO, private ) Private Public Public NGO Public Public Public Guidelines used for ART efficacy monitoring(b) SADI/MOH MOH MOH MOH/PAHO MOH MOH MOH Recommendations of CD4+ monitoring frequency 3-4 months 3-6 months 3-4 months(c) 6 months 6 months 4-6 months 6 months Cost of CD4+ T cell US$7.37 US$17.62 US$64.09 US$32.6 US$14.31(d) US$59.67 US$38.12 measurement US$33.39 Source of funding for Social Insurance Federal Government Federal Government PEPFAR and Government Program Federal Government Government CD4+ cells refund from Program Program Global Fund and Social Insurance Program Program measurements Federal Government Cost of HIV RNA level US$55.26 US$20.34 US$119.14 US$186.28 US$33.39 US$119.27 US$86.32 measurement US$160.19 Source of funding for Social Insurance Federal Government Federal Government Research projects Government Program Federal Government Government RNA level refund from Program Program and Social Insurance Program Program measurements Federal Government a 1991 to mono therapy, 1994 to dual therapy and 1996 to HAART. VL and CD4 became freely available around 1997. b SADI Sociedad Argentina de Infectologà a, MOH Ministery of Health, PAHO Pan American Health Organization c Each 6 months in case the patient is undetectable, according last guidelines Dec 2013 d The first is the government cost and the second is the Instituto HondureÃśo de Seguro Social cost. d Prices from the Peruvian National Institute of Health offered to public institutions e Cost in US Dollars of July 9th 2014.
5 Table 2: Summary of Patient Demographics by Site CMH- FC- FA- GHESKIO- IHSS/HE- INCMNSZ- IMTAvH- Argentina Brazil Chile Haiti Honduras Mexico Peru (n=1285) (n=2446) (n=1080) (n=5696) (n=789) (n=772) (n=2408) (n=14476) Patient age (years) 37 (31 43) 38 (30 44) 37 (31 44) 39 (32 46) 37 (30 43) 38 (32 46) 34 (29 41) 37 (31 44) Male 1778 (73%) 859 (63%) 534 (86%) 2095 (43%) 269 (49%) 460 (87%) 1524 (72%) 7519 (60%) Probable Infection Route, n(%) Heterosexual 515 (21%) 109 (8%) 61 (10%) 0 (0%) 58 (11%) 76 (14%) 525 (25%) 1344 (11%) Homosexual 605 (25%) 805 (59%) 222 (36%) 0 (0%) 86 (16%) 154 (29%) 595 (28%) 2467 (20%) other 988 (40%) 199 (15%) 329 (53%) 0 (0%) 357 (65%) 273 (51%) 267 (13%) 2413 (19%) Unknown 340 (14%) 249 (18%) 8 (1%) 4828 (100%) 47 (9%) 28 (5%) 728 (34%) 6228 (50%) CD4 at HAART, n(%) Missing 1507 (62%) 653 (48%) 322 (52%) 2601 (54%) 345 (63%) 364 (69%) 1220 (58%) 7012 (56%) <200 284 (30%) 233 (33%) 135 (45%) 1007 (45%) 119 (59%) 70 (42%) 473 (53%) 2321 (43%) >350 372 (40%) 279 (39%) 77 (26%) 571 (26%) 27 (13%) 44 (26%) 178 (20%) 1548 (28%) 200-350 285 (30%) 197 (28%) 86 (29%) 649 (29%) 57 (28%) 53 (32%) 244 (27%) 1571 (29%) AIDS 84 (3%) 332 (24%) 160 (26%) 564 (12%) 37 (7%) 119 (22%) 574 (27%) 1870 (15%) AIDS or CD4<200 359 (15%) 493 (36%) 255 (41%) 1457 (30%) 149 (27%) 178 (34%) 926 (44%) 3817 (31%) HAART Regimen, n(%) NNRTI 1470 (60%) 905 (66%) 454 (73%) 4519 (94%) 517 (94%) 389 (73%) 1915 (91%) 10169 (82%) non NNRTI 978 (40%) 457 (34%) 166 (27%) 309 (6%) 31 (6%) 142 (27%) 200 (9%) 2283 (18%) a Continuous variables are reported as medians (interquartile range). Table 3: Number and Cost of CD4 and VL counts per patient per year by site CMH- FC- FA- GHESKIO- IHSS/HE- INCMNSZ- IMTAvH- Argentina Brazil Chile Haiti Honduras Mexico Peru (n=1285) (n=2446) (n=1080) (n=5696) (n=789) (n=772) (n=2408) (n=14476) CD4 1.8 (1.3 2.6) 2 (1.3 2.8) 1.9 (1.3 2.7) 2 (1.3 3.1) 1.7 (1.2 2.3) 1.8 (1.3 2.7) 1.9 (1.3 2.8) 1.9 (1.3 2.9) Cost 13 (9 19) 34 (22 50) 119 (84 176) 68 (45 106) 24 (17 33) 110 (76 163) 73 (49 107) 51 (25 91) VL 1.8 (1.3 2.6) 2 (1.3 2.9) 1.9 (1.3 2.8) 1.7 (1.2 2.3) 1.8 (1.3 2.7) 1.9 (1.3 2.8) 1.9 (1.3 2.7) Cost 99 (70 144) 40 (26 58) 222 (157 331) 271 (191 372) 219 (152 326) 166 (110 242) 125 (68 218) a Continuous variables are reported as medians (interquartile range). b Costs in US Dollars (2014)
Figure 3: Rate ratios for different predictors of adequate CD4/VL monitoring by site and combined across sites; Graphical analogue of Table S1 in Supplementary material. Rate ratio for males Rate ratio for CD4 200 350 vs CD4<200 cells/ml at ART initiation Rate ratio for non NNRTI vs. NNRTI based regimen 0.99 1.01 1.04 1.06 1.08 1.10 Rate ratio for year at ART initiation 0.98 1.02 1.05 1.10 1.15 Rate ratio for age (per 10 years) Rate ratio for CD4>350 vs CD4<200 cells/ml at ART initiation Rate ratio for AIDS defining event at ART initiation 6
Figure 4: Rate ratios for different predictors of adequate CD4 monitoring by site and combined across sites; Graphical analogue of Table S2 in Supplementary material Rate ratio for males Rate ratio for CD4 200 350 vs CD4<200 cells/ml at ART initiation Rate ratio for non NNRTI vs. NNRTI based regimen 0.93 0.95 0.98 1.00 1.02 1.05 Rate ratio for year at ART initiation 0.98 1.02 1.05 1.10 Rate ratio for age (per 10 years) Rate ratio for CD4>350 vs CD4<200 cells/ml at ART initiation Rate ratio for AIDS defining event at ART initiation 7
1 Appendix - R/Package Versions R version 3.2.1 (2015-06-18), x86_64-apple-darwin13.4.0 Base packages: base, datasets, graphics, grdevices, grid, methods, stats, stats4, utils Other packages: Matrix 1.2-1, mi 1.0, rmeta 2.16, xtable 1.8-0 Loaded via a namespace (and not attached): abind 1.4-3, arm 1.8-6, coda 0.18-1, lattice 0.20-31, lme4 1.1-10, MASS 7.3-40, minqa 1.2.4, nlme 3.1-128, nloptr 1.0.4, Rcpp 0.12.0, splines 3.2.1, tools 3.2.1 8