Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec:128:83-92.
doi: 10.1016/j.jclinepi.2020.08.012. Epub 2020 Aug 20.

Loss to follow-up correction increased mortality estimates in HIV-positive people on antiretroviral therapy in Mozambique

Nanina Anderegg  1 , Jonas Hector  2 , Laura F Jefferys  2 , Juan Burgos-Soto  2 , Michael A Hobbins  3 , Jochen Ehmer  3 , Lukas Meier  4 , Marloes H Maathuis  4 , Matthias Egger  5
Affiliations

Loss to follow-up correction increased mortality estimates in HIV-positive people on antiretroviral therapy in Mozambique

Nanina Anderegg et al. J Clin Epidemiol. 2020 Dec.

Abstract

Objectives: People living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART) may be lost to follow-up (LTFU), which hampers the assessment of outcomes. We estimated mortality for patients starting ART in a rural region in sub-Saharan Africa and examined risk factors for death, correcting for LTFU.

Study design and setting: We analyzed data from Ancuabe, Mozambique, where patients LTFU are traced by phone and home visits. We used cumulative incidence functions to estimate mortality and LTFU. To correct for LTFU, we revised outcomes based on tracing data using different inverse probability weights (maximum likelihood, Ridge regression, or Bayesian model averaging). We fitted competing risk models to identify risk factors for death and LTFU.

Results: The analyses included 4,492 patients; during 8,152 person-years of follow-up, 486 patients died, 2,375 were LTFU, 752 were traced, and 603 were found. At 4 years after starting ART, observed mortality was 11.9% (95% confidence interval [CI]: 10.9-13.0), but 23.5% (95% CI: 19.8-28.0), 21.6% (95% CI: 18.7-25.0), and 23.3% (95% CI: 19.7-27.6) after correction with maximum likelihood, Ridge regression, and Bayesian model averaging weights, respectively. The risk factors for death included male sex, lower CD4 cell counts, and more advanced clinical stage.

Conclusion: In ART programs with substantial LTFU, mortality estimates need to take LTFU into account.

Keywords: AIDS; HIV; Highly active antiretroviral therapy; Loss to follow-up; Mortality; Mozambique.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Cumulative incidences of outcomes in patients starting ART, including death, loss to follow-up (LTFU) and being alive. Below the plots, cumulative probabilities (95%-CI) for outcomes at 1–4 years after starting ART are shown. Panel A) reports uncorrected estimates, Panel B)-D) corrected ones (ML weights, RIDGE weights, BMA weights).
Figure 2:
Figure 2:
Adjusted hazard ratios (aHR) for outcome death, uncorrected and corrected for true outcomes in patients lost to follow-up.
Figure 3:
Figure 3:
Adjusted hazard ratios (aHR) for loss to follow-up (LTFU), uncorrected and corrected for true outcomes in patients LTFU.
See this image and copyright information in PMC

References

    1. Egger M, May M, Chêne G, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet (London, England) 2002; 360:119–29. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12126821. - PubMed
    1. Boulle A, Schomaker M, May MT, et al. Mortality in Patients with HIV-1 Infection Starting Antiretroviral Therapy in South Africa, Europe, or North America: A Collaborative Analysis of Prospective Studies. PLoS Med. 2014; 11:e1001718. Available at: 10.1371/journal.pmed.1001718. - DOI - PMC - PubMed
    1. World Health Organization (WHO). Retention in hiv programmes: Defining the challenges and identifying solutions. Meet. Report, 13-15 September. 2011, Geneva 2011; :71.
    1. Zürcher K, Mooser A, Anderegg N, et al. Outcomes of HIV-positive patients lost to follow-up in African treatment programmes. Trop. Med. Int. Heal 2017; 22:375–387. Available at: 10.1111/tmi.12843. - DOI - PMC - PubMed
    1. Fox MP, Rosen S. Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries. JAIDS J. Acquir. Immune Defic. Syndr 2015; 69:98–108. Available at: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=0.... - PMC - PubMed

Publication types

Substances