Design and Development of a Risk Classification Instrument for Virological Failure in HIV, Using Psychosocial Determinan
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ORIGINAL PAPER
Design and Development of a Risk Classification Instrument for Virological Failure in HIV, Using Psychosocial Determinants of Health: Preliminary Evidence from a South American Country Angela J. Pereira‑Morales1,2 · Diana Acero Torres1 · Mary Moreno Zapata1 · Pedro Moreno Sierra1 · Jhon Astaiza Hurtado1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Predictive approaches in HIV to estimate a patient’s risk to present with relevant health outcomes, such as hospitalizations and AIDS-related death, long before they happen, could be highly useful. We aimed to develop a risk classification instrument for virological failure through a scoring system that identifies patients with a low, medium, and high risk after six months of ART treatment. A case–control design was implemented through 355 HIV-positive Colombian adults who were assessed using the designed instrument. The variables with independent predictive values were selected using logistic regression analysis, and the diagnostic performance of the prediction score was evaluated using the area under the curve. The prediction score included relevant psychosocial and biological risk factors, some of them modifiable variables like substance use and low health literacy. The area under the curve value for the total prediction score was 0.85 (CI 0.80–0.90). Therefore, this instrument could be a valuable tool to identify at-risk patients of virological failure. In low and middle-income countries, the associated risk factors of virological failure are little known. Assessing such risk would lead to make individualized decisions regarding the patient’s management and minimize the chance of non-desirable outcomes. Keywords HIV/AIDS · Virological failure · Risk management · Prediction score · South America
Introduction According to the 2019 Joint United Nations Programme on HIV/AIDS (UNAIDS) data, Latin America was far to achieve the viral load suppression goal. Nonetheless, access to antiretroviral therapy was near to 80%; up to date, there is a significant gap to reaching the first (90% diagnosed) and third (90% virally suppressed) 90 of the UNAIDS 90–90–90 targets to end the AIDS epidemic by 2030 [1]. Though access to antiretroviral therapy (ART) has improved clinical results, little is known about the risk factors for virological failure (VF) in the South American region. Viral loads below the accepted umbral of 50 copies * Angela J. Pereira‑Morales [email protected] 1
Sociedad Integral de Especialistas en Salud (SIES Salud IPS), Bogotá, Colombia
PhD Program in Public Health, Universidad Nacional de Colombia, Bogotá, Colombia
2
are relevant to reaching essential health outcomes such as restoration of immune function and avoiding progression to AIDS and death [2]. Also, virological suppression decreases the ability of HIV to develop antiretroviral resistance [3]. In low- and middle-income countries, outpatient HIV/ AIDS care programs face numerous challenges related to care and treatment, including the l
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