Andrianopoulos, N

Bloch, M

Carr, A

Cunningham, N

Hoy, J

Rayner, C

Roth, N

English

PubMed

M Bloch

J Hoy

N Cunningham

N Roth

N Andrianopoulos

C Rayner

A Carr

Crossref

Journal of the International AIDS Society

Adherence to HIV treatment guidelines for initiation of antiretroviral therapy in Australia

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Adherence to HIV treatment guidelines for
initiation of antiretroviral therapy in Australia
M Bloch1, J Hoy2, N Cunningham1*, N Roth3, N Andrianopoulos4, C Rayner2, A Carr5
From Tenth International Congress on Drug Therapy in HIV Infection
Glasgow, UK. 7-11 November 2010
Background
In Australia, the DHHS guidelines for treatment of
adults and adolescents have been adopted with an
Australian Commentary.
Purpose of the study
An audit was conducted to determine adherence to
these guidelines.
Methods
Case records were examined of 500 sequential adults
initiating ART in primary care and hospital sites (125
per site) in Sydney and Melbourne from 2004 to 2008
inclusive. Data on ART initiation and regimen pre-
scribed, as well as adherence to all specific guidelines on
patient management and monitoring, were recorded.
Results
Of 500 subjects initiating ART (by 54 physicians with
mean 14 years HIV experience), 95% were male (mean
age 40 years, CD4 count 287 cells/µL, HIV RNA 89,000
copies/mL). ART initiation was mean 3.1 years after diag-
nosis, via clinical trial in 20.4% and as hospital in-patient
in 7.7%. For “When to start”, adherence to Dec 1 2009
guidelines was 91%, 82% for Nov 3 2008 guidelines, and
88% for guidelines current at ART initiation. Preferred or
alternative regimens were prescribed (after exclusion of
patients receiving experimental clinical trial regimens) in
79%, 90%, and 89%, according to 2009, 2008 and guide-
lines current at ART initiation, respectively. Preferred
regimen was prescribed according to guidelines in 50%,
55% and 65%, respectively. Contraindicated ART was
prescribed in 4%. Strong recommendations (level A) in
2008 guidelines were adhered to variably: for hepatitis
serology (74%), oral/dental check (63%), fasting lipids
(52%), fasting glucose (47%), CMV serology (50%), resis-
tance testing (48%), vaccination history 39%, Chlamydia
screening (38%), gonorrhea screening (36%), chest X ray
(35%), pap smear (32%), urinalysis (26%), and TB testing
(9%). Sydney patients were more likely than Melbourne
patients to have co-morbidity history assessed (96% vs
62%, p<0.0001), and to commence ART via a clinical trial
(36% vs 5%, p<0.0001), but less likely to have treatment
adherence ability assessed (62 vs 84%, p<0.0001) with no
significant difference in STI testing. Hospital sites were
more likely than GP sites to perform investigations -
resistance testing (71 vs 46%, p<0.0001), but less likely to
discuss lifestyle health promotion (36% vs 63%, p<0.001).
Conclusions
HIV treatment guidelines in primary care and hospital
sites in Australia have been largely adhered to for when
to start and what to start with, but less closely followed
for co-morbidity related parameters.
Author details
1Holdsworth House Medical Practice, Sydney, Australia. 2Alfred Hospital,
Monash University, Melbourne, Australia. 3Prahan Market Clinic, Melbourne,
Australia. 4Monash University, Melbourne, Australia. 5St Vincents Hospital,
Sydney, Australia.
Published: 8 November 2010
doi:10.1186/1758-2652-13-S4-P172
Cite this article as: Bloch et al.: Adherence to HIV treatment guidelines
for initiation of antiretroviral therapy in Australia. Journal of the
International AIDS Society 2010 13(Suppl 4):P172.
1Holdsworth House Medical Practice, Sydney, Australia
Full list of author information is available at the end of the article
Bloch et al. Journal of the International AIDS Society 2010, 13(Suppl 4):P172
http://www.jiasociety.org/content/13/S4/P172
© 2010 Cunningham et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.


file:///data/remote/core/dit/data/Springer-OA/pdf/376/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjExODYvMTc1OC0yNjUyLTEzLVM0LVAxNzIucGRm.pdf

Adherence to HIV treatment guidelines for initiation of antiretroviral therapy in Australia

Abstract

Similar works

Full text

Available Versions

Crossref

Springer - Publisher Connector

Springer - Publisher Connector