{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T01:04:31Z","timestamp":1777770271744,"version":"3.51.4"},"reference-count":36,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,9]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterise temporal trends in antiretroviral therapy (ART) utilisation and forecast short-term changes in regimen distribution within a provincial HIV treatment programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-level longitudinal analysis of administrative drug dispensation data combined with time-series forecasting using recurrent neural network (RNN) models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The British Columbia (BC) Centre for Excellence in HIV\/AIDS Drug Treatment Program (DTP), which centrally coordinates and records all publicly funded ART dispensations in BC, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All ART dispensations recorded in the DTP between fiscal years 2014\/2015 and 2023\/2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Temporal changes in ART dispensation volume and regimen market share. Forecasts of regimen utilisation were generated using drug-specific RNN models, and predictive performance was evaluated using different measures, including mean absolute percentage error (MAPE) and mean absolute error. Forecast uncertainty was presented using 95% prediction intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ART utilisation patterns changed substantially over the study period. Dispensation of second-generation integrase strand transfer inhibitor (INSTI)-based regimens, particularly dolutegravir- and bictegravir-containing combinations, increased steadily, while utilisation of several older regimens, including generic formulations, declined in relative market share. RNN models demonstrated strong predictive performance during temporal validation, with validation MAPE ranging from 0.27% to 2.26% across regimens. For example, the model forecasting bictegravir\/emtricitabine\/tenofovir alafenamide utilisation showed a validation MAPE of 0.27%, indicating very small prediction error during temporal validation. Forecasts suggest that second-generation INSTI-based regimens will continue to account for the majority of ART dispensation volume within the provincial programme in the near term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over the past decade, ART utilisation in BC has shifted from older and generic regimens towards newer second-generation INSTI-based combinations. These changes illustrate evolving treatment patterns within a publicly funded HIV programme and may have implications for long-term programme planning as newer therapies replace existing treatment options. In addition, this study demonstrated the potential application of machine learning-based forecasting approaches for analysing pharmaceutical utilisation patterns using administrative health data. Such approaches may complement traditional pharmacoepidemiological methods and provide additional tools for monitoring treatment trends and informing health system planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110123","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:31:26Z","timestamp":1777480286000},"page":"e110123","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Evolution and forecasting of antiretroviral therapy utilisation in British Columbia: a population-level analysis of provincial drug treatment programme data, 2014\u20132024"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4943-091X","authenticated-orcid":false,"given":"Viviane D","family":"Lima","sequence":"first","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS, Vancouver, British Columbia, Canada"},{"name":"Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4872-7447","authenticated-orcid":false,"given":"Ali","family":"Mokhtari Jazi","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio S G","family":"Montaner","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS, Vancouver, British Columbia, Canada"},{"name":"Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026042909301454000_16.4.e110123.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198707233170401"},{"key":"2026042909301454000_16.4.e110123.2","unstructured":"Lima VD , Montaner JS . The Epidemiological Transition of the HIV Epidemic in British Columbia. Vancouver, BC, Canada: British Columbia Pharmacare, 2019."},{"key":"2026042909301454000_16.4.e110123.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60936-1"},{"key":"2026042909301454000_16.4.e110123.4","unstructured":"HIVinfo.NIH.gov . FDA-Approved HIV Medicines. 2026. Available: https:\/\/hivinfo.nih.gov\/understanding-hiv\/fact-sheets\/fda-approved-hiv-medicines [Accessed 20 Apr 2026]."},{"key":"2026042909301454000_16.4.e110123.5","unstructured":"Public Health Agency of Canada . Summary: HIV antiretroviral medication coverage in Canada. Ottawa, Canada; 2023. Available: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/diseases-conditions\/summary-hiv-antiretroviral-medication-coverage.html"},{"key":"2026042909301454000_16.4.e110123.6","unstructured":"Centre for Excellence in HIV\/AIDS . Vancouver, Canada; HIV\/AIDS Drugs Available Through the BC-CfE Drug Treatment Program (Formulary list \u2013 version Sept 25, 2023), 2023. Available: https:\/\/bccfe.ca\/wp-content\/uploads\/2023\/12\/hiv_aids-drugs-available-through-the-bc-cfe_v2023_25_09.pdf [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.7","first-page":"1649","article-title":"HIV-1 Integrase Inhibitors: A Comparative Review of Efficacy and Safety","volume":"80","author":"Scarsi","year":"2020","journal-title":"Drugs (Abingdon Engl)"},{"key":"2026042909301454000_16.4.e110123.8","unstructured":"British Columbia Centre for Excellence in HIV\/AIDS . Therapeutic Guidelines for Antiretroviral (ARV) Treatment of Adult HIV Infection, 2020. Available: https:\/\/bccfe.ca\/bccfe-documents\/therapeutic-guidelines-for-antiretroviral-arv-treatment-of-adult-hiv-infection [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.9","unstructured":"World Health Organization . Update of Recommendations on First- and Second-Line Antiretroviral Regimens \u2013 Policy Brief Geneva, Switzerland, 2019. Available: https:\/\/www.who.int\/publications\/i\/item\/WHO-CDS-HIV-19.15 [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.10","unstructured":"British Columbia Centre for Excellence in HIV\/AIDS . Drug Treatment Program 2019, Available: https:\/\/bccfe.ca\/drug-treatment-programs [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.11","doi-asserted-by":"crossref","unstructured":"Rutherford GW , Horvath H . Dolutegravir plus two NRTIs versus efavirenz plus two NRTIs as first-line therapy for people with HIV: a systematic review. PLoS ONE 2016;11. doi:10.1371\/journal.pone.0162775","DOI":"10.1371\/journal.pone.0162775"},{"key":"2026042909301454000_16.4.e110123.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0239704","article-title":"De-simplifying single-tablet antiretroviral treatments for cost savings in France: From the patient perspectives to a 6-month follow-up on generics","volume":"15","author":"Giraud","year":"2020","journal-title":"PLoS One"},{"key":"2026042909301454000_16.4.e110123.13","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-2-201301150-00002"},{"key":"2026042909301454000_16.4.e110123.14","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/hiv.12824","article-title":"Updated direct costs of medical care for HIV-infected patients within a regional population from 2006 to 2017","volume":"21","author":"Krentz","year":"2020","journal-title":"HIV Med"},{"key":"2026042909301454000_16.4.e110123.15","unstructured":"Canadian Agency for Drugs Technologies in Health . CDEC final recommendation: dolutegravir (tivicay). CADTH; 2014. Available: https:\/\/www.cda-amc.ca\/sites\/default\/files\/cdr\/complete\/cdr_complete_tivicay_august_20_2014.pdf"},{"key":"2026042909301454000_16.4.e110123.16","unstructured":"Canadian Agency for Drugs and Technologies in Health . CDEC final recommendation: bictegravir\/emtricitabine\/tenofovir alafenamide (biktarvy). CADTH; 2018. Available: https:\/\/www.cda-amc.ca\/sites\/default\/files\/cdr\/complete\/SR0567%20Biktarvy%20-%20CDEC%20Final%20Recommendation%20October%2029%2C%202018.pdf"},{"key":"2026042909301454000_16.4.e110123.17","doi-asserted-by":"crossref","unstructured":"Abade A , Porto LF , Scholze AR , et al . A comparative analysis of classical and machine learning methods for forecasting TB\/HIV co-infection. Sci Rep 2024;14. doi:10.1038\/s41598-024-69580-4","DOI":"10.1038\/s41598-024-69580-4"},{"key":"2026042909301454000_16.4.e110123.18","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.ijforecast.2019.07.001","article-title":"DeepAR: Probabilistic forecasting with autoregressive recurrent networks","volume":"36","author":"Salinas","year":"2020","journal-title":"Int J Forecast"},{"key":"2026042909301454000_16.4.e110123.19","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/MLR.0000000000000097","article-title":"Antiretroviral drug costs and prescription patterns in British Columbia, Canada: 1996-2011","volume":"52","author":"Nosyk","year":"2014","journal-title":"Med Care"},{"key":"2026042909301454000_16.4.e110123.20","doi-asserted-by":"crossref","first-page":"e393","DOI":"10.1016\/S2352-3018(15)00127-7","article-title":"Cost-effectiveness of population-level expansion of highly active antiretroviral treatment for HIV in British Columbia, Canada: a modelling study","volume":"2","author":"Nosyk","year":"2015","journal-title":"Lancet HIV"},{"key":"2026042909301454000_16.4.e110123.21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.24543"},{"key":"2026042909301454000_16.4.e110123.22","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540020068031"},{"key":"2026042909301454000_16.4.e110123.23","unstructured":"British Columbia Centre for Excellence in HIV\/AIDS . HIV\/AIDS Drugs available through the BC-CfE, 2021. Available: https:\/\/bccfe.ca\/wp-content\/uploads\/2023\/12\/hiv_aids-drugs-available-through-the-bc-cfe_v2023_25_09.pdf [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.24","unstructured":"British Columbia Ministry of Health . PharmaCare 2022. Available: https:\/\/www2.gov.bc.ca\/gov\/content\/health\/health-drug-coverage\/pharmacare-for-bc-residents [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.25","unstructured":"British Columbia Centre for Excellence in HIV\/AIDS . How to Obtain HIV Medication through the Drug Treatment Program, 2021. Available: https:\/\/bccfe.ca\/how-to-obtain-hiv-treatment-medication [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.26","unstructured":"British Columbia Centre for Excellence in HIV\/AIDS . Generic Antiretroviral Products Available on BC-CfE Formulary British Columbia, Canada2018, 2018. Available: https:\/\/bccfe.ca\/wp-content\/uploads\/2024\/05\/dear_prescriber_generic_antiretroviral_products_5_july_2018.pdf [Accessed 15 Apr 2025]."},{"key":"2026042909301454000_16.4.e110123.27","unstructured":"Goodfellow I , Bengio Y , Courville A . Deep Learning. Adapt Comput Mach Le 2016;1\u2013775."},{"key":"2026042909301454000_16.4.e110123.28","doi-asserted-by":"publisher","DOI":"10.1162\/neco.1997.9.8.1735"},{"key":"2026042909301454000_16.4.e110123.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijforecast.2006.03.001"},{"key":"2026042909301454000_16.4.e110123.30","doi-asserted-by":"publisher","DOI":"10.3354\/cr030079"},{"key":"2026042909301454000_16.4.e110123.31","unstructured":"Ng AY . Feature selection, l1 vs. l2 regularization, and rotational invariance. Proceedings of the 21st International Conference on Machine Learning; Banff, Alberta, Canada,"},{"key":"2026042909301454000_16.4.e110123.32","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/3-540-49430-8_3","article-title":"Early stopping - But when?","volume":"1524","author":"Prechelt","year":"1998","journal-title":"Lect Notes Comput Sc"},{"key":"2026042909301454000_16.4.e110123.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60423-7"},{"key":"2026042909301454000_16.4.e110123.34","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq231"},{"key":"2026042909301454000_16.4.e110123.35","doi-asserted-by":"publisher","DOI":"10.1086\/655681"},{"key":"2026042909301454000_16.4.e110123.36","unstructured":"British Columbia Centre for Excellence in HIV\/AIDS . BC-CfE; Status Reports: BC-CfE Drug Treatment Program Monthly Reports Vancouver, British Columbia, 2025. Available: https:\/\/bccfe.ca\/status-reports"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:31:38Z","timestamp":1777480298000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,29]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2025-110123"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110123","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}