Katherine Heath - Academia.edu (original) (raw)

Papers by Katherine Heath

PubMed, Aug 1, 1996

The aims of this study were to assess the degree of heterogeneity in the knowledge of therapeutic... more The aims of this study were to assess the degree of heterogeneity in the knowledge of therapeutic management of HIV infection among HIV-experienced physicians in British Columbia, Canada, and to identify associations between physician characteristics and their agreement with contemporary therapeutic guidelines. A self-administered anonymous questionnaire was mailed to 6500 physician members of the British Columbia Medical Association. The questionnaire provided information about demographic and personal characteristics, including sex, age, medical specialization and practice location; level of experience in treating HIV-infected patients; use of HIV testing procedures; use of preventative vaccinations and tests; and preferred approaches to antiretroviral therapy and the prophylaxis and acute treatment of opportunistic infections. We compared physicians' patterns of knowledge with contemporary recommendations. Logistic regression identified associations between physician characteristics and their agreement with contemporary guidelines. A total of 463 HIV-experienced physicians (a high proportion of the HIV-experienced physicians in British Columbia, Canada) responded to the questionnaire. The agreement with contemporary guidelines about HIV testing and preventative vaccinations and tests among responders ranged from 27% to 71%. For antiretroviral therapy, agreement with the guidelines ranged from 12% to 35%. For the prophylaxis and treatment of opportunistic infections, agreement with the guidelines ranged from 11% to 89% (prophylaxis) and from 46% to 91% (treatment). Regression analysis revealed that physicians actively involved in the care of HIV-infected patients were more likely to agree with the guidelines in all areas of patient care. General practitioners were more likely to agree with the guidelines regarding preventative therapies, and male general practitioners under 45 years old were more likely to agree with the guidelines on antiretroviral therapy. Our data confirm that there is substantial heterogeneity in the management of HIV-associated disease, including some deviations from contemporary guidelines. Concordance with contemporary guidelines increased with the physician's level of HIV-related experience. Our results support the idea that adherence to state-of-the-art practices may be responsible, at least in part, for the recently described association between physician experience and improved survival of HIV-infected individuals.

Antiviral Therapy

Objective To identify patient and physician characteristics that may act as determinants of adher... more Objective To identify patient and physician characteristics that may act as determinants of adherence to prescription refill of triple combination antiretroviral therapy. Methods A population-based analysis of antiretroviral therapy-naive HIV-positive men and women in British Columbia, Canada, who initiated triple combination therapy between August 1 1996 and October 31 1998. Study participants were considered adherent if they were actually dispensed antiretrovirals ≥95% over the first year of therapy. Log-binomial regression was used to identify patient and physician characteristics associated with adherence to prescription refill. Results Of the 886 individuals eligible for analysis, 495 (56%) were ≥95% adherent to prescription refill. In multivariate analysis, adherence was positively associated with increased age [adjusted relative rate (ARR) 1.19; 95% CI: 1.07–1.32], having a diagnosis of AIDS (ARR 1.66; 95% CI: 1.29–2.15), being male (ARR 1.79; 95% CI: 1.27–2.53), and with gre...

AIDS (London, England), Jan 15, 1997

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 7, 2003

Because of established links between entrenched poverty and risk of HIV infection, there have lon... more Because of established links between entrenched poverty and risk of HIV infection, there have long been warnings that HIV/AIDS will disproportionately affect Aboriginal people in Canada. We compared HIV incidence rates among Aboriginal and non-Aboriginal injection drug users (IDUs) in Vancouver and studied factors associated with HIV seroconversion among Aboriginal participants. This analysis was based on 941 participants (230 Aboriginal people) recruited between May 1996 and December 2000 who were seronegative at enrollment and had completed at least one follow-up visit. Incidence rates were calculated using the Kaplan-Meier method. The Cox proportional hazards regression model was used to identify independent predictors of time to HIV seroconversion among female and male Aboriginal IDUs. As of May 31, 2001, seroconversion had occurred in 112 (11.9%) of the participants, yielding a cumulative incidence of HIV infection at 42 months of 12.7% (95% confidence interval [CI] 10.3%-15.1%...

PloS one, 2012

We aimed to characterize changes in patterns of new HIV diagnoses, HIV-related mortality, and HAA... more We aimed to characterize changes in patterns of new HIV diagnoses, HIV-related mortality, and HAART use in Canada from 1995 to 2008. Data on new HIV diagnoses were obtained from Health Canada, HIV-related mortality statistics were obtained from Statistics Canada, and information on the number of people on HAART was obtained from the single antiretroviral distribution site in British Columbia (BC), and the Intercontinental Marketing Services Health for Ontario and Quebec. Trends of new HIV-positive tests were assessed using Spearman rank correlations and the association between the number of individuals on HAART and new HIV diagnoses were estimated using generalized estimating equations (GEE). A total of 34,502 new HIV diagnoses were observed. Rates of death in BC are higher than those in Ontario and Quebec with the rate being 2.03 versus 1.06 and 1.21 per 100,000 population, respectively. The number of HIV infected individuals on HAART increased from 5,091 in 1996 to 20,481 in 2008 ...

The Journal of Infectious Diseases, 2004

Background. The prevalence of antiretroviral resistance among persons enrolled in the centralized... more Background. The prevalence of antiretroviral resistance among persons enrolled in the centralized HIV/AIDS Drug Treatment Program in British Columbia, Canada, who had died between July 1997 and December 2001, was investigated, to determine the degree to which antiretroviral resistance contributed to mortality. Methods. During this period, 637 deaths had occurred. The last plasma sample obtained during therapy was genotyped retrospectively for treated individuals who had died of a nonaccidental cause. Samples with plasma human immunodeficiency virus (HIV) loads !500 copies/mL were not genotyped. Drug resistance among 1220 living HIVinfected persons who had experienced virologic therapy failure during the study period also was examined. Results. Of 554 individuals who had died of nonaccidental causes, 58 (10.4%) were antiretroviral naive, and 99 (17.9%) had very brief exposure to antiretroviral therapy (median, 2 months). The majority of isolates from the remaining 397 individuals harbored either no major resistance mutations or represented samples with plasma HIV suppression of !500 copies/mL. Resistance to у1, у2, or 3 drug classes was observed in 76%, 42%, and 11% of individuals, respectively, in the group of 1220 living individuals experiencing virologic therapy failure, compared with only 44%, 23%, and 5% of individuals, respectively, who had died (). P ! .001 Conclusion. Only a relatively low prevalence of multidrug resistance was observed in this cohort, indicating that the exhaustion of treatment options because of drug resistance was not a significant contributor to mortality. Morbidity and mortality associated with HIV infection and AIDS have declined significantly in North America and Western Europe as a result of the introduction of combination antiretroviral therapies [1-6]. Despite these advances in treatment, HIV-related deaths continue to occur across the developed world [1-4, 7, 8]. Drug-resistant HIV variants are often cited as a major barrier to long-term antiretroviral efficacy and a major cause of treatment failure [9-16]. However, what pro

JAMA: The Journal of the American Medical Association, 1998

International Journal of Epidemiology, 2014

The Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort is a census of all i... more The Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort is a census of all identified HIV-positive individuals in the province of British Columbia. It was formed through the linkage of nine provincial treatment, surveillance and administrative databases. This open cohort allows for bidirectional analyses from 1996 onward and is refreshed annually. Extensive data collection for cohort members includes demographic information, detailed clinical and laboratory data, complete prescription drug use including antiretroviral agents, and information on health service utilization encompassing inpatient and outpatient care, addictions treatment and palliative care. This cohort provides an unprecedented opportunity to evaluate, over an extended time period, patterns and determinants of key outcomes including engagement in the cascade of HIV care from diagnosis to treatment to viral suppression as well as monitoring trends in medical costs, health outcomes and other key healthcare delivery indicators at a population level with wide-ranging, high-quality data. The overall purpose of these activities is to enable the development and implementation of strategically targeted interventions to improve access to testing, care and treatment for all HIV-positive individuals living in British Columbia. As a programme of the Ministry of Health, the STOP HIV/AIDS Evaluation Evaluation Team welcomes input from all stakeholders and possible partners via contact with the Director of Operations for the British Columbia Centre for excellence in HIV AIDS, Ms. Irene Day

AIDS Care, 1999

The objective of this study is to determine the opinions of a random sample of Canadian family ph... more The objective of this study is to determine the opinions of a random sample of Canadian family physicians and a population of non-specialist physicians known to provide care to persons with HIV/AIDS about the legalization of physician assisted suicide for persons with HIV disease. In addition, we have attempted to ascertain the physician characteristics that may be associated with a favourable or negative opinion. Self-administered, anonymous questionnaires were mailed to 2,890 family physicians across Canada. Logistic regression analysis was used to determine whether physician characteristics were predictive of agreement with the legalization of physician assisted suicide. Of the respondents who had an opinion, 60% agreed with the legalization of physician assisted suicide. Multivariate analyses indicated that physicians who were living in the provinces of British Columbia (BC), Ontario, or Québec (OR = 1.63, 95% CI: 1.10, 2.43) and who provided routine follow-up care (OR = 1.85, 95% CI: 1.30, 2.63) or palliative care (OR 1.66, 95% CI: 1.13, 2.44) to those with HIV disease were more likely to agree with legalization of physician assisted suicide. This analysis demonstrates a strong support for the legalization of physician assisted suicide for persons with HIV disease among physicians experienced in providing care to those affected.

AIDS, 1996

OBJECTIVE To assess the impact of HIV infection and AIDS on mortality patterns in Canada with spe... more OBJECTIVE To assess the impact of HIV infection and AIDS on mortality patterns in Canada with specific reference to gender and regional differentials and to other leading causes of death. DESIGN Descriptive, population-based study. SETTING Canada. PATIENTS All persons for whom HIV/AIDS [ninth revision of the International Classification of Diseases (ICD-9) 042-044] was recorded as the underlying cause of death as reported to Statistics Canada between 1987 and 1992. For comparative purposes data was obtained on five other leading underlying causes of death including coronary heart disease (ICD-9 410-414), motor vehicle accidents (ICD-9 E810-E819), and suicides (ICD-9 E950-E959) in men and women, lung cancer (ICD-9 162) in men and breast cancer (ICD-9 174) in women. Population figures were obtained from Statistics Canada estimates. MAIN OUTCOME MEASURES Age and cause-specific mortality rates, standardized mortality ratios (SMR), potential years of life lost (PYLL) before age 65 years, and life expectancy lost due to a select underlying cause of death. RESULTS Over the period 1 January 1987 to 31 December 1992, 5546 deaths attributed to HIV/AIDS (5229 in men and 317 in women) were recorded in Canada. SMR for men were significantly higher than the national average in the cities of Vancouver, Toronto and Montreal, whereas those for women were significantly greater only in Montreal. Deaths from HIV/AIDS accounted for 3.6% of PYLL in men and 0.4% of PYLL in women. In 1992, HIV/AIDS was the third leading cause of male PYLL surpassing lung cancer. In the cities of Montreal, Toronto, and Vancouver HIV/AIDS was the leading cause of PYLL and was responsible for significant decrease in life expectancy at birth in men over the study period. CONCLUSIONS HIV/AIDS has had considerable impact on mortality within Canada, principally among men and particularly in the cities of Toronto, Vancouver and Montreal.

Journal of acquired immune deficiency syndromes (1999), 2014

In light of accumulated scientific evidence of the secondary preventive benefits of antiretrovira... more In light of accumulated scientific evidence of the secondary preventive benefits of antiretroviral therapy, a growing number of jurisdictions worldwide have formally started to implement HIV Treatment as Prevention (TasP) programs. To date, no gold standard for TasP program monitoring has been described. Here, we describe the design and methods applied to TasP program process monitoring in British Columbia (BC), Canada. Monitoring indicators were selected through a collaborative and iterative process by an interdisciplinary team including representatives from all 5 regional health authorities, the BC Centre for Disease Control (BCCDC), and the BC Centre for Excellence in HIV/AIDS (BC-CfE). An initial set of 36 proposed indicators were considered for inclusion. These were ranked on the basis of 8 criteria: data quality, validity, scientific evidence, informative power of the indicator, feasibility, confidentiality, accuracy, and administrative requirement. The consolidated list of in...

In the HPTN 052 trial, antiretroviral treatment (ART) lowered the risk of HIV transmission by 96%... more In the HPTN 052 trial, antiretroviral treatment (ART) lowered the risk of HIV transmission by 96% in sero-discordant couples [1]. Increased ART coverage has also been associated with lower rates of HIV transmission at the community level [2]. The aims of this study were (1) to investigate the relationship between the percentage of HIV infected individuals on ART and HIV incidence in a multi-country analysis; (2) To compare ART coverage rates between low, middle and high-income countries.

Journal of Virus Eradication, 2018

Objective In 2014, UNAIDS and partners set the 90-90-90 targets for the HIV treatment cascade. Mu... more Objective In 2014, UNAIDS and partners set the 90-90-90 targets for the HIV treatment cascade. Multiple social, political and structural factors might influence progress towards these targets. We assessed how close countries and regions are to reaching these targets, and compared cascade outcomes with HIV prevalence, gross domestic product (GDP)/capita, conflict and corruption. Methods Country-level HIV cascade data on diagnosis, ART coverage and viral suppression, from 2010 to 2016 were extracted from national reports, published papers and the www.AIDSinfoOnline database, and analysed. Weighted least-squares regression was used to assess predictors of cascade achievement: region, HIV prevalence, GDP/capita, the 2016 Corruption Perceptions Index (CPI), which is an international ranking system, and the 2016 Global Peace Index (GPI), which ranks all countries based on three main categories: societal safety, militarisation and conflict. Results Data were available for diagnosis for 84 ...

SSRN Electronic Journal, 2020

Journal of Virus Eradication, 2015

Objectives: Diagnosis and treatment of HIV-infected mothers significantly lower rates of mother-t... more Objectives: Diagnosis and treatment of HIV-infected mothers significantly lower rates of mother-to-child transmission (MTCT) of HIV. Early infant diagnosis (EID) is required to monitor success of prevention of MTCT (pMTCT) programmes. Our aim was to compare rates of MTCT, EID and pMTCT in countries with generalised epidemics. Methods: The UNAIDSinfo database includes country-level information on epidemic size, prevalence of HIV infection, EID rates and pMTCT coverage. The AIDS Spectrum model was used to estimate the number of children infected with HIV in 2013, for 32 countries with generalised epidemics. Least squares linear regression, weighted by epidemic size and controlling for GDP/capita, was used to correlate national adult HIV prevalence with estimated MTCT rates. Results: There were 32 countries with generalised epidemics included in the analysis (31 in Africa). Higher-prevalence countries (≥5%) had significantly lower rates of MTCT (P<0.01) than lower-prevalence countries (<5%). For 20 lower-prevalence countries (total 7.4 million HIV-infected people), there were 105,300 childhood (0-14 years) infections in 2013. In 12 higher-prevalence countries (total 17.1 million HIV-infected people), there were an estimated 107,500 childhood infections in 2013. Regression analysis suggests that if all countries achieved the same MTCT rate as Botswana (2.0%), childhood HIV infections could be cut by 88% (from 105,300 to 12,300 per year) in lower-prevalence countries, and by 82% (from 107,500 to 19,700 per year) in higher-prevalence countries. Conclusions: In this analysis of 32 countries with generalised HIV epidemics, 49.5% (105,500/213,000) of childhood HIV infections in 2013 were in lower-prevalence countries. Targeting of prevention of MTCT in lower-prevalence countries needs to be prioritised, despite challenges, to reduce the number of children infected.

Journal of Virus Eradication, 2019

Objectives: The Joint United nations Programme on hiV/aiDs (UnaiDs) targets aim to reduce new hiV... more Objectives: The Joint United nations Programme on hiV/aiDs (UnaiDs) targets aim to reduce new hiV infections below 500,000 per year by 2020. Despite targeted prevention programmes, total new infections remained in 2016 and 2017 at 1,800,000 cases. We have aimed to analyse data from 2017 and to compare hiV incidence, aiDs-related deaths and provision of antiretroviral therapy (arT) to adults, pregnant women and children living with hiV in lowerand higher-prevalence countries. Vertical or mother-to-child transmission (MTcT) and early infant diagnosis (eiD) rates were also investigated. Methods: UnaiDsinfo data use the spectrum model to represent country-level hiV data. countries with epidemics over 40,000 hiV cases were separated into higher prevalence (≥4.5%) and lower prevalence (<4.5%). least squares linear regression, weighted by epidemic size and controlled for gross domestic product/capita, was used to compare hiV prevalence with estimated arT coverage in adults (≥15 years), children (0-14 years), pregnant women, and eiD rates and MTcT rates. Data were then compared between higher-and lower-prevalence groups, including numbers of new hiV infections and aiDs-related deaths. Results: Data were available for 56 countries. Twelve higher-prevalence countries accounted for 16.7 million and 44 lower-prevalence ones for 15.1 million people living with hiV, altogether making up 87.5% of the global estimate. lowerprevalence countries had less arT coverage for adults, pregnant women and children, lower eiD rates and higher aiDsrelated death levels. There were more new hiV infections in adults and children in lower-than higher-prevalence countries. Conclusions: Most new hiV infections, MTcTs and aiDs-related deaths occurred in countries with an hiV prevalence rate below 4.5%. Many of these countries are not targeted by access programmes, such as the President' emergency Plan for aiDs relief. More intensive programmes of diagnosis and treatment are needed in these countries in the effort to reduce global new hiV infections below 500,000 per year by 2020.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 17, 2015

Achievement of a sustained virologic response (SVR) after treatment for Hepatitis C infection is... more Achievement of a sustained virologic response (SVR) after treatment for Hepatitis C infection is associated with improved outcomes. This meta-analysis aimed to determine the impact of SVR on long-term mortality risk compared with non-responders in a range of populations. An electronic search identified all studies assessing all-cause mortality in SVR and non-SVR patients. Eligible articles were stratified into general, cirrhotic, and HIV co-infected populations. The adjusted hazard ratio (95%CI) for mortality in patients achieving SVR versus non-SVR, and pooled estimates for the five-year mortality in each group were calculated. 31 studies (n=33,360) were identified as suitable for inclusion. Median follow-up time was 5.4 years (IQR 4.9-7.5) across all studies. The adjusted hazard ratio of mortality for patients achieving SVR versus non-SVR was 0.50 (95%CI 0.37-0.67) in the general population, 0.26 (95%CI 0.18-0.74) in the cirrhotic group, and 0.21 (0.10-0.45) in the co-infected ...

AIDS, 2007

Background: We undertook a study to examine the fertility intentions and reproductive health issu... more Background: We undertook a study to examine the fertility intentions and reproductive health issues of women living with HIV in a broad-based sample in British Columbia, Canada. Methods: Between November 2003 and December 2004, we invited women with HIV at all HIV clinics and AIDS service organizations in the province of British Columbia, Canada, to complete the survey instrument 'Contraceptive Decisions of HIV-positive Women'. Logistic regression analysis was conducted to calculate adjusted odds ratios to identify factors that may be significant predictors of the intention of women living with HIV to have children. Results: Of the 230 surveys completed, 182 women (79.1%) were of reproductive age (44 years), and 25.8% of women living with HIV indicated an intention to have children. In multivariate modeling, non-aboriginal ethnicity, younger age and having a regular partner were associated with an increased likelihood of reporting the intention to have children in the future. Discussion: In this study, we found that the predictors of fertility intention of women with HIV were age, ethnicity and marital status. Women who were HIV-positive described an intention to have children at levels approaching those among the general population and regardless of their clinical HIV status. Public policy planners and health practitioners need to consider and plan for the implications of increased numbers of women with HIV who may choose to have children.ß 2007 Lippincott Williams & Wilkins

Clinical and investigative medicine. Médecine clinique et experimentale

To determine the knowledge of HIV-disease management and the adherence to contemporary guidelines... more To determine the knowledge of HIV-disease management and the adherence to contemporary guidelines among British Columbia physicians whose practices focused on HIV/AIDS. Self-administered mail survey. All 659 physicians registered in a province-wide HIV/AIDS drug treatment program. Data on demographic and personal characteristics of respondents, level of HIV-related experience, use of preventive vaccinations and tests, and preferred approaches to the prophylaxis and treatment of common opportunistic infections. Knowledge scores in 4 areas of patient care, as well as an overall score, were computed by comparing respondents' answers with the therapeutic strategies recommended at the time of the survey. Associations between physician characteristics and knowledge scores were identified by linear regression analysis. Of the 659 physicians surveyed, 65% returned responses: only 38% returned completed surveys while a further 27% returned a follow-up survey that asked nonrespondents about their demographic characteristics and HIV-related experience. Scores for specific areas of patient management ranged from 29% for the treatment of opportunistic infections to 62% for preventive measures, with a mean overall score of 47%. Physician knowledge in all areas of patient care was associated with the number of HIV-positive patients in the practice (p = 0.003 to p < 0.001). Physicians who were younger were more knowledgeable regarding preventive measures (p = 0.001); those whose practice location was in Vancouver had a greater knowledge of prophylaxis (p = 0.047); and those who had medical specialty training were more knowledgeable about the treatment of opportunistic infections (p = 0.009). There is substantial disparity in how physicians approach the management of HIV and related conditions. Deviations from therapeutic guidelines are common and may be associated with physician characteristics, particularly lack of experience in managing HIV.