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Genotypic Inference of HIV-1 Tropism Using Population-based Sequencing of V3
Published on: December 27, 2010
Application and validation of case-finding algorithms for identifying individuals with human immunodeficiency virus
Bohdan Nosyk1, Guillaume Colley, Benita Yip
1BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
Insights
This study successfully defined a population-level human immunodeficiency virus (HIV) cohort in British Columbia using administrative data. Validated algorithms achieved 88% sensitivity, enabling robust HIV surveillance and research.
Area of Science:
- Public Health and Epidemiology
- Health Informatics
- Biostatistics
Background:
- Accurate population-level data is crucial for understanding and managing public health challenges like HIV.
- Existing registries and administrative datasets offer potential for cohort identification but require robust validation.
- Defining a comprehensive human immunodeficiency virus (HIV) cohort in British Columbia (BC) is essential for effective public health strategies.
Purpose of the Study:
- To establish a population-level cohort of individuals with human immunodeficiency virus (HIV) in British Columbia.
- To utilize and validate case-finding algorithms for identifying HIV cases within provincial administrative and registry data.
- To assess the accuracy and sensitivity of the developed case-finding algorithm.
Main Methods:
- Individuals were identified from multiple BC health databases, including drug treatment, laboratory results, and surveillance records.
- A validated case-finding algorithm was applied to distinguish true HIV cases from potential misclassifications.
- Algorithm sensitivity was assessed by comparing identified cases against confirmed HIV records; a priori hypotheses verified excluded cases.
Main Results:
- A total of 25,673 individuals with HIV-related health records were identified.
- The case-finding algorithm identified 849 additional probable HIV-positive individuals from 9,454 unconfirmed cases, achieving 88% sensitivity.
- Excluded individuals were more likely female and exhibited lower mortality and health service utilization rates compared to the cohort.
Conclusions:
- Validated case-finding algorithms provide a robust framework for defining population-level HIV cohorts using administrative data.
- This methodology enables comprehensive HIV surveillance and research in British Columbia.
- The study demonstrates the feasibility of leveraging administrative health databases for epidemiological cohort definition.
Objective:
To define a population-level cohort of individuals infected with the human immunodeficiency virus (HIV) in the province of British Columbia from available registries and administrative datasets using a validated case-finding algorithm.
Methods:
Individuals were identified for possible cohort inclusion from the BC Centre for Excellence in HIV/AIDS (CfE) drug treatment program (antiretroviral therapy) and laboratory testing datasets (plasma viral load (pVL) and CD4 diagnostic test results), the BC Centre for Disease Control (CDC) provincial HIV surveillance database (positive HIV tests), as well as databases held by the BC Ministry of Health (MoH); the Discharge Abstract Database (hospitalizations), the Medical Services Plan (physician billing) and PharmaNet databases (additional HIV-related medications). A validated case-finding algorithm was applied to distinguish true HIV cases from those likely to have been misclassified. The sensitivity of the algorithms was assessed as the proportion of confirmed cases (those with records in the CfE, CDC and MoH databases) positively identified by each algorithm. A priori hypotheses were generated and tested to verify excluded cases.
Results:
A total of 25,673 individuals were identified as having at least one HIV-related health record. Among 9,454 unconfirmed cases, the selected case-finding algorithm identified 849 individuals believed to be HIV-positive. The sensitivity of this algorithm among confirmed cases was 88%. Those excluded from the cohort were more likely to be female (44.4% vs. 22.5%; p<0.01), had a lower mortality rate (2.18 per 100 person years (100PY) vs. 3.14/100PY; p<0.01), and had lower median rates of health service utilization (days of medications dispensed: 9745/100PY vs. 10266/100PY; p<0.01; days of inpatient care: 29/100PY vs. 98/100PY; p<0.01; physician billings: 602/100PY vs. 2,056/100PY; p<0.01).
Conclusions:
The application of validated case-finding algorithms and subsequent hypothesis testing provided a strong framework for defining a population-level cohort of HIV infected people in BC using administrative databases.
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