The effect of AIDS Clinical Trials Group Protocol 5164 on the time from Pneumocystis jirovecii pneumonia diagnosis to antiretroviral initiation in routine clinical practice: a case study of diffusion, dissemination, and implementation.

TitleThe effect of AIDS Clinical Trials Group Protocol 5164 on the time from Pneumocystis jirovecii pneumonia diagnosis to antiretroviral initiation in routine clinical practice: a case study of diffusion, dissemination, and implementation.
Publication TypeJournal Article
Year of Publication2011
AuthorsGeng EH, Kahn JS, Chang OC, C Hare B, Christopoulos KA, Jones D, Petersen ML, Deeks SG, Havlir DV, Gandhi M
JournalClin Infect Dis
Volume53
Issue10
Pagination1008-14
Date Published2011 Nov
ISSN1537-6591
KeywordsAdult, AIDS-Related Opportunistic Infections, Antiretroviral Therapy, Highly Active, Diffusion of Innovation, Female, HIV Infections, Humans, Male, Middle Aged, Pneumocystis jirovecii, Pneumonia, Pneumocystis, Randomized Controlled Trials as Topic, Time Factors, Treatment Outcome, Viral Load
Abstract

BACKGROUND: Diffusion, dissemination, and implementation of scientific evidence into routine clinical practice is not well understood. The Adult AIDS Clinical Trials Group (ACTG) Protocol 5164 showed that early antiretroviral therapy (ART; ie, within 14 days) after diagnosis of an opportunistic infection improved clinical outcomes, compared with later initiation. Subsequently, the San Francisco General Hospital (SFGH) HIV/AIDS Service performed the SFGH 5164 Initiative to disseminate and implement the findings of ACTG 5164.

METHODS: We evaluated patients who received a diagnosis of Pneumocystis jirovecii pneumonia (PCP) from 1 January 2001 through 30 March 2011. Survival analyses were used to assess changes in the time to initiation of ART after PCP, and logistic regression was used to evaluate changes in the odds of early ART (ie, within 14 days) because of ACTG 5164 and SFGH 5164 Initiative.

RESULTS: Among 162 patients, the adjusted hazard of ART initiation increased by 3.05 (95% confidence interval [CI], 1.86-5.02) after ACTG 5164 and by 4.89 (95% CI, 2.76-8.67) after the SFGH Initiative, compared with before ACTG 5164. When compared with before ACTG 5164, the proportion of patients who received ART within the 14 days after PCP diagnosis increased from 7.4% to 50.0% (P < .001) after ACTG 5164 and from 50.0% to 83.0% (P = .02) after the SFGH 5164 Initiative.

CONCLUSIONS: Diffusion of findings from of a randomized trial changed practice at an academic medical center, but dissemination and implementation efforts were required to establish early ART at acceptable levels. Early ART initiation can be achieved in real-world patient populations.

DOI10.1093/cid/cir608
Alternate JournalClin. Infect. Dis.
PubMed ID21960715
PubMed Central IDPMC3193829
Grant ListK23 AI084544 / AI / NIAID NIH HHS / United States
K23 AI084544 / AI / NIAID NIH HHS / United States
K23 MH092220 / MH / NIMH NIH HHS / United States
K24 AI051982 / AI / NIAID NIH HHS / United States
MH 088341 / MH / NIMH NIH HHS / United States
P30 AI027763 / AI / NIAID NIH HHS / United States
R18 HS17784 / HS / AHRQ HHS / United States
R24 A067039 / / PHS HHS / United States
RR 024369 / RR / NCRR NIH HHS / United States