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Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting

Author

Listed:
  • Nancy Puttkammer
  • Steven Zeliadt
  • Jean Gabriel Balan
  • Janet Baseman
  • Rodney Destiné
  • Jean Wysler Domerçant
  • Garilus France
  • Nathaelf Hyppolite
  • Valérie Pelletier
  • Nernst Atwood Raphael
  • Kenneth Sherr
  • Krista Yuhas
  • Scott Barnhart

Abstract

Background: The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk. Methods: Among adult patients enrolled on ART from 2005–2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6–12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves. Results: Among 923 patients with CD4 results available during the period 6–12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p

Suggested Citation

  • Nancy Puttkammer & Steven Zeliadt & Jean Gabriel Balan & Janet Baseman & Rodney Destiné & Jean Wysler Domerçant & Garilus France & Nathaelf Hyppolite & Valérie Pelletier & Nernst Atwood Raphael & Kenn, 2014. "Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-12, November.
    • Handle: RePEc:plo:pone00:0112261
    DOI: 10.1371/journal.pone.0112261
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    References listed on IDEAS

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    1. Margaret S. Pepe & Gary Longton & Holly Janes, 2009. "Estimation and comparison of receiver operating characteristic curves," Stata Journal, StataCorp LP, vol. 9(1), pages 1-16, March.
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    Cited by:

    1. Margaret L McNairy & Deanna Jannat-Khah & Jean W Pape & Adias Marcelin & Patrice Joseph & Jean Edward Mathon & Serena Koenig & Martin Wells & Daniel W Fitzgerald & Arthur Evans, 2018. "Predicting death and lost to follow-up among adults initiating antiretroviral therapy in resource-limited settings: Derivation and external validation of a risk score in Haiti," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-16, August.

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