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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

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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.

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Acknowledgements

This work was supported by Sociedad Integral de Especialistas en Salud (SIES), Bogotá, Colombia. We thank all the patients participating in the study and the SIES professionals responsible for the development of health programs, for their valuable assistance. Besides, we are particularly grateful to all the infectious diseases physicians, psychologists, and nurses working in the health centers for their dedicated contribution to the research projects. The authors also thank Dr. Ernesto Martinez for their scientific advice.

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Authors and Affiliations

  1. Sociedad Integral de Especialistas en Salud (SIES Salud IPS), Bogotá, Colombia

    Angela J. Pereira-Morales, Diana Acero Torres, Mary Moreno Zapata, Pedro Moreno Sierra & Jhon Astaiza Hurtado

  2. PhD Program in Public Health, Universidad Nacional de Colombia, Bogotá, Colombia

    Angela J. Pereira-Morales

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  1. Angela J. Pereira-Morales
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Correspondence to Angela J. Pereira-Morales.

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The Research Ethics Committee of the SIES Salud IPS approved the study protocol, and all participants signed a written informed consent. The study followed the principles embodied in the Declaration of Helsinki.

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Pereira-Morales, A.J., Acero Torres, D., Moreno Zapata, M. et al. 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. AIDS Behav 25, 623–633 (2021). https://doi.org/10.1007/s10461-020-03025-7

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