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Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis

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Chammartin, Frédérique, Zürcher, Kathrin, Keiser, Olivia, Weigel, Ralf, Chu, Kathryn, Kiragga, Agnes N, ArduraGarcia, Cristina, Anderegg, Nanina, Laurent, Christian, Cornell, Morna, Tweya, Hannock, Haas, Andreas D, Rice, Brian D, Geng, Elvin H, Fox, Matthew P, Hargreaves, James R and Egger, Matthias (2018) 'Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis'. Clinical Infectious Diseases, Vol 67, Issue 11, pp. 1643-1652.

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Abstract

Background
Low retention on combination antiretroviral therapy (cART) has emerged as a threat to the Joint United Nations Programme on human immunodeficiency virus (HIV)/AIDS (UNAIDS) 90-90-90 targets. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African treatment programs.

Methods
This was a systematic review and individual patient data meta-analysis of studies that traced patients who were LTFU. Outcomes were analyzed using cumulative incidence functions and proportional hazards models for the competing risks of (i) death, (ii) alive but stopped cART, (iii) silent transfer to other clinics, and (iv) retention on cART.

Results
Nine studies contributed data on 7377 patients who started cART and were subsequently LTFU in sub-Saharan Africa. The median CD4 count at the start of cART was 129 cells/μL. At 4 years after the last clinic visit, 21.8% (95% confidence interval [CI], 20.8%–22.7%) were known to have died, 22.6% (95% CI, 21.6%–23.6%) were alive but had stopped cART, 14.8% (95% CI, 14.0%–15.6%) had transferred to another clinic, 9.2% (95% CI, 8.5%–9.8%) were retained on cART, and 31.6% (95% CI, 30.6%–32.7%) could not been found. Mortality was associated with male sex, more advanced disease, and shorter cART duration; stopping cART with less advanced disease andlonger cART duration; and silent transfer with female sex and less advanced disease.

Conclusions
Mortality in patients LTFU must be considered for unbiased assessments of program outcomes and UNAIDS targets in sub-Saharan Africa. Immediate start of cART and early tracing of patients LTFU should be priorities.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268.5 Antiviral agents (General)
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
Faculty: Department: Clinical Sciences & International Health > Well Travelled Clinic (WTC)
Digital Object Identifer (DOI): https://doi.org/10.1093/cid/ciy347
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 18 Jun 2018 09:42
Last Modified: 29 Nov 2018 11:32
URI: http://archive.lstmed.ac.uk/id/eprint/8766

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