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Nonfinancial Factors Associated With Decreased Plasma Viral Load Testing in Ontario, Canada

Raboud, Janet M PhD*†; Abdurrahman, Zainab B MSc; Major, Carol MSc§; Millson, Peggy MD; Robinson, Greg MD, MHSc; Rachlis, Anita MD†∥; Bayoumi, Ahmed M MD†¶

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2005 - Volume 39 - Issue 3 - p 327-332
doi: 10.1097/01.qai.0000143603.94728.b2
Epidemiology and Social Science

Objective: To examine whether individual characteristics were associated with differential use of viral load testing when testing is available without charge to all HIV-positive patients with provincial health insurance.

Methods: Individuals enrolled in the HIV Ontario Observational Database with complete medication records and health insurance numbers for linkage were studied. Generalized estimating equation regression models were used to examine the relationship between time-varying covariates such as plasma viral load levels, CD4 counts, and antiretroviral regimen characteristics and the number of days between viral load tests and the occurrence of an interval of ≥6 or 9 months between tests.

Results: A total of 1032 individuals were included in the analysis with a median follow-up of 4.6 years and a median of 18 viral load tests. In multivariate analyses, clinically important gaps in viral load testing were more likely among injection drug users (odds ratio [OR] = 1.86, P < 0.0001), in more recent years (P < 0.01) and for individuals not using antiretrovirals (OR = 1.70, P < 0.0001) and less likely among individuals using >4 antiretrovirals (OR = 0.62, P < 0.0001). Results were similar when the outcome was the number of days between tests.

Conclusions: Injection drug users, younger individuals, and residents of Toronto used fewer viral load tests than other individuals, even when financial barriers to testing were removed.

From the *Division of Infectious Diseases, University Health Network, and †Faculty of Medicine, University of Toronto, Ontario, Canada; ‡Department of Statistics and Actuarial Science, University of Waterloo, Ontario, Canada; §Ontario HIV Treatment Network, Toronto, Ontario, Canada; ∥Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada; ¶Inner City Health Research Unit, St. Michael's Hospital, Toronto, Ontario, Canada; and Community Linked Evaluation AIDS Resource, McMaster University, Hamilton, Ontario, Canada.

Received for publication November 3, 2003; accepted August 17, 2004.

Dr. Bayoumi is supported by a Career Scientist Award from the Ontario HIV Treatment Network. Dr. Raboud is supported by the Skate the Dream Fund, Toronto General and Western Hospital Foundation.

Reprints: Janet Raboud, Prosserman Center for Health Research, 60 Murray St., Toronto, Ontario M5G 1X5, Canada (e-mail: raboud@mshri.on.ca).

© 2005 Lippincott Williams & Wilkins, Inc.