Evaluating Clinician Responses to Treatment Failure in Patients Living with HIV in La Romana, Dominican Republic
Name: Nadia Goldberg
School: Vagelos College of Physicians and Surgeons, Class of 2026; Varmus Global Scholar 2023
Mentors: Adriana Tiburcio, MD and Michael Yin, MD, MS
Abstract
Research Question: How accurately are clinicians following the national protocol in cases of treatment failure in patients living with HIV? How confident do clinicians feel in their ability to treat patients who are in treatment failure?
Background: Clinicians at Clínica de Familia in La Romana (CFLR) treat 2,500 patients living with HIV. Some patients who are taking antiretrovirals but have a detectable viral load are in treatment failure. The goals of this Quality Improvement research were to determine if treatment failure was diagnosed and treated properly, and to interview clinicians on their confidence in their ability to treat this population of patients.
Methods: 75 patients with a viral load above 5,000 copies were randomly selected from the patient database. Patient records were reviewed to determine if clinicians followed the national protocol by repeating labs within eight weeks, addressing issues of absorption/adherence/interactions, and changing to an appropriate 2nd or 3rd line medication when indicated.
Results: Of the 75 patients with detectable viral loads, 57 patients were non-adherent to medication and 18 patients were in treatment failure. Of these 18 patients, there were 7 cases where the physician failed to follow the protocol due to challenges related to TB/HIV drug interactions, cross resistance, or delayed lab results.
Conclusions: These results show that clinicians may benefit from continuing education regarding the national protocol, especially in cases of TB/HIV drug interactions or cross resistance. Developing a model to more accurately determine the time it takes to return lab results may also benefit the ability of physicians to follow protocol.