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TLD and Viral Loads Analysis

  • We want to establish if people ever started or switched to TLD had a latest Viral Load done or captured and

  • In the case the Viral Loads were captured or done, was the Viral load at least less than 6 months from the start/switch date?

  • If the VL was at least 6 months, was it suppressed (<50, <400?)

  • We want to compare VL Counts before and immediately after the switch to TLD

  • We want to describe the Current VL Completion and Suppression rates for patients on TLD

Approach and methods

  • We 1st identified all patients ever started or ever switched to TLD for the 2 Districts.
  • The regimen used was 1T3O and not anything else containing Dolutagravir.
  • Use exploratory (descriptive) approach to understand the Viral Loads relationship to the TLD just before and after the switch

Findings

TLD Start and Switch Summaries

  • Anyone on TLD from month 0 to 3 for treatment is considered as having started on TLD.

    Up to 83234 patients were ever switched to TLD in Capricorn and up to 90958 ever switched to TLD in Mopani. Up to 24238 patients were ever started on TLD in Capricorn and up to 22165 patients were ever started on TLD in Mopani. The chart below shows the trends as well as the percent of started compared to all ( started + switched) for different calendar quarters.

    Figure 1.1: Chart showing trends in Switch vs Started on TLD over number of patients started on TLD or switched to TLD from 2020 ( Calendar quarters(Qtr)) ( end of April 2023)

pivot<-Start_Switch_dedup%>%
dcast(District+Sub_District+Facility+Month~Start_Switch,fun.aggregate = length,value.var="PatientID",margins =F)

Viral Loads Done/Captured before switch

Table 1.1 Summary of number and percentage of non-VLs documentation ( n) as a proportion of the total number of patients switched to TLD (%) ( end of April 2023)

Up to 3,7 % of clients were switched to TLD without a documented VL due to non-capturing or due to clinicians not doing the viral loads. - File audits of these patients is prescribed to establish whether this is a data capturing problem or a clinical practice problem.

Viral Loads more than 6 months old before start/Switch to TLD

An investigation into the latest VL before the switch or start on TLD was done and the table below shiwa the findings.

Table 1.2 Frequency table showing numbers switched or started on TLD with the latest Viral loads more than 6 months from the day of switch/start.

- Up to 39,8% of the patients had a latest Viral loads that was more than 6 months from the date of switching to TLD.

- Of the patients that had Viral loads less than 6 months from the date of start/switch, 3837were having a Viral load >1000 c/ml in Capricorn and 3373 had a Viral Load >1000c/ml in Mopani.

This again is either an indication of non-adherence to clinical guidelines OR non-capturing of Viral Loads into Tier.net.

Figure 1.2: TLD Cascade ( Mopani and Capricorn) by end of April 2023

Comparison of Viral Load Counts before and after switch to TLD

Comparing the VL count before the switch and after the switch was done.

Exclusion/Inclusion criteria

  • Only Viral loads less than 6 months before the switch/start and
  • VLs at least 12 months after the switch were considered
  • VLs more than 12 months apart are excluded

Due to the coded values (“19”) for lower than detectable, methods like t-tests or box plot visualizations will not give a good picture, as the data will show skew and also as suppression rates are between 80-90 %. The approach is to quantify how many patients improved VL and how many moved from Non-Suppression, >50c/ml to <=50 c/ml.

- In Capricorn, 3055 patients became unsuppressed after switching to TLD, 7933 remained suppressed ,63 remained unsuppressed and 4828 became suppressed.

- In Mopani, 3426 patients became unsuppressed after switching to TLD, 5998 remained suppressed ,70 remained unsuppressed and 4553 became suppressed.

Please note that this is however not a reflection of the current VL status of TLD clients but a History of what happened at the time of switching to TLD.

Current Viral Load Completion and Suppression of clients on TLD

Note: Hospitals excluded from the analysis.

Viral load analysis for all patients currently on ART and at least more than 6 months on treatment shows that the completion rate for TLD clients is 89,7% vs the 88,9 % for other regimens for Capricorn and 79,9 % vs 79,5 % for Mopani.

The Viral Load Suppression rate ( <50c/ml) for clients on TLD is 77,7 % against 53,6 % for those on other regimens in Capricorn and 71,8 % vs 46,8 % in Mopani.

Conclusion

Please comment on the findings on the link below to facilitate deeper analysis to intervene and improve on these findings where necessary.

Other Regimens

Next time, deal with “Stopped and Did not Attend

Get Folder numbers of Children <10 on TFE and TLD