Correcting for Mortality Among Patients Lost to Follow Up on Antiretroviral Therapy in South Africa: A Cohort Analysis
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{"title"=>"Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: A cohort analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Gilles", "last_name"=>"van Cutsem", "scopus_author_id"=>"24768129500"}, {"first_name"=>"Nathan", "last_name"=>"Ford", "scopus_author_id"=>"7102556235"}, {"first_name"=>"Katherine", "last_name"=>"Hildebrand", "scopus_author_id"=>"7006070549"}, {"first_name"=>"Eric", "last_name"=>"Goemaere", "scopus_author_id"=>"6602922805"}, {"first_name"=>"Shaheed", "last_name"=>"Mathee", "scopus_author_id"=>"6506159321"}, {"first_name"=>"Musaed", "last_name"=>"Abrahams", "scopus_author_id"=>"24491516500"}, {"first_name"=>"David", "last_name"=>"Coetzee", "scopus_author_id"=>"8508288500"}, {"first_name"=>"Andrew", "last_name"=>"Boulle", "scopus_author_id"=>"6602727118"}], "year"=>2011, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"361318946", "sgr"=>"79951878920", "issn"=>"19326203", "pmid"=>"21379378", "scopus"=>"2-s2.0-79951878920", "doi"=>"10.1371/journal.pone.0014684", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)"}, "id"=>"bd6d753e-d94d-3843-ab4a-ed4c45cd6e85", "abstract"=>"BACKGROUND: Loss to follow-up (LTF) challenges the reporting of antiretroviral treatment (ART) programmes, since it encompasses patients alive but lost to programme and deaths misclassified as LTF. We describe LTF before and after correction for mortality in a primary care ART programme with linkages to the national vital registration system. METHODS AND FINDINGS: We included 6411 patients enrolled on ART between March 2001 and June 2007. Patients LTF with available civil identification numbers were matched with the national vital registration system to ascertain vital status. Corrected mortality and true LTF were determined by weighting these patients to represent all patients LTF. We used Kaplan-Meier estimates and Cox regression to describe LTF, mortality among those LTF, and true LTF. Of 627 patients LTF, 85 (28.8%) had died within 3 months after their last clinic visits. Respective estimates of LTF before and after correction for mortality were 6.9% (95% confidence interval [CI] 6.2-7.6) and 4.3% (95% CI 3.5-5.3) at one year on ART, and 23.9% (95% CI 21.0-27.2) and 19.7% (95% CI 16.1-23.7) at 5 years. After correction for mortality, the hazard of LTF was reversed from decreasing to increasing with time on ART. Younger age, higher baseline CD4 count, pregnancy and increasing calendar year were associated with higher true LTF. Mortality of patients LTF at 1, 12 and 24 months after their last visits was respectively 23.1%, 30.9% and 43.8%; 78.0% of deaths occurred during the first 3 months after last visit and 45.0% in patients on ART for 0 to 3 months. CONCLUSIONS: Mortality of patients LTF was high and occurred early after last clinic visit, especially in patients recently started on ART. Correction for these misclassified deaths revealed that the risk of true LTF increased over time. Research targeting groups at higher risk of LTF (youth, pregnant women and patients with higher CD4 counts) is needed.", "link"=>"http://www.mendeley.com/research/correcting-mortality-among-patients-lost-follow-up-antiretroviral-therapy-south-africa-cohort-analys", "reader_count"=>89, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>5, "Researcher"=>24, "Student > Doctoral Student"=>9, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>4, "Student > Master"=>17, "Other"=>8, "Student > Bachelor"=>3, "Lecturer > Senior Lecturer"=>2, "Professor"=>5}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>5, "Researcher"=>24, "Student > Doctoral Student"=>9, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>4, "Student > Master"=>17, "Other"=>8, "Student > Bachelor"=>3, "Lecturer > Senior Lecturer"=>2, "Professor"=>5}, "reader_count_by_subject_area"=>{"Unspecified"=>2, "Nursing and Health Professions"=>5, "Mathematics"=>3, "Medicine and Dentistry"=>55, "Agricultural and Biological Sciences"=>5, "Business, Management and Accounting"=>3, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>1, "Social Sciences"=>11, "Computer Science"=>3}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>55}, "Social Sciences"=>{"Social Sciences"=>11}, "Psychology"=>{"Psychology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Computer Science"=>{"Computer Science"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>5}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Mathematics"=>{"Mathematics"=>3}, "Unspecified"=>{"Unspecified"=>2}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}}, "reader_count_by_country"=>{"United States"=>1, "Niger"=>1, "South Africa"=>3, "France"=>1, "Switzerland"=>1}, "group_count"=>9}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/797014"], "description"=>"<p>Summary diagram of patient outcomes.</p>", "links"=>[], "tags"=>["diagram"], "article_id"=>467379, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.g001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_diagram_of_patient_outcomes_/467379", "title"=>"Summary diagram of patient outcomes.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 20:26:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/797127"], "description"=>"<p>Kaplan-Meier estimates of cumulative probability of loss to follow-up (LTF) before and after correction for mortality by ascertainment of vital status of patients lost to follow-up through the national vital registration system. Routine monitoring overestimated LTF by 4% at 5 years on ART (23.9 vs. 19.7%).</p>", "links"=>[], "tags"=>["probability", "ltf", "correction"], "article_id"=>467491, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.g002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cumulative_probability_of_LTF_before_and_after_correction_for_mortality_/467491", "title"=>"Cumulative probability of LTF before and after correction for mortality.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 20:26:52"}
  • {"files"=>["https://ndownloader.figshare.com/files/797181"], "description"=>"<p>Smoothed hazard estimates for loss to follow-up (LTF) before (A) and after (B) correction for mortality. Before ascertainment of vital status the hazard of LTF decreased over time on ART; after correcting LTF for mortality, the hazard of true LTF increased with time on ART.</p>", "links"=>[], "tags"=>["follow-up", "ascertainment"], "article_id"=>467550, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.g003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Smoothed_hazard_of_loss_to_follow_up_before_and_after_ascertainment_of_vital_status_/467550", "title"=>"Smoothed hazard of loss to follow-up before and after ascertainment of vital status.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 20:27:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/797246"], "description"=>"<p>Weighted Kaplan-Meier estimates of true LTF by year of initiation on ART. True LTF increased and occurred earlier with each calendar year, as enrolment on ART increased.</p>", "links"=>[], "tags"=>["probability", "ltf", "initiation"], "article_id"=>467615, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.g004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cumulative_probability_of_true_LTF_by_year_of_initiation_on_ART_/467615", "title"=>"Cumulative probability of true LTF by year of initiation on ART.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 20:27:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/797319"], "description"=>"<p>These Kaplan-Meier graphs show cumulative mortality over time after the last recorded visit for patients originally classified as LTF in whom vital status could be ascertained through the national vital registration system: A - among all LTF; B - among LTF on ART for less than 3 months; C stratified by duration on ART at time of LTF; D stratified by CD4 cell count at initiation on ART. Patients recently started on ART and with lower CD4 counts had higher mortality after LTF. LTF, loss to follow-up.</p>", "links"=>[], "tags"=>["public health and epidemiology", "infectious diseases/hiv infection and aids", "public health and epidemiology/epidemiology"], "article_id"=>467687, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.g005"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cumulative_mortality_after_LTF_/467687", "title"=>"Cumulative mortality after LTF.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 20:27:52"}
  • {"files"=>["https://ndownloader.figshare.com/files/797394"], "description"=>"<p>ART, antiretroviral treatment; LTF, Lost to follow-up; IQR, interquartile range; PMTCT, prevention of mother to child transmission; TB, tuberculosis; AZT, zidovudine; 3TC, lamivudine; NVP, nevirapine; D4T, stavudine; EFV, efavirenz. </p><p>* All patients not lost to follow-up, including deaths occurring within 3 months after loss to follow-up;</p><p>** Patients lost to follow-up with available civil identification number who were alive 3 months after being lost.</p>", "links"=>[], "tags"=>["characteristics", "initiation"], "article_id"=>467759, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Patient_characteristics_at_initiation_of_ART_/467759", "title"=>"Patient characteristics at initiation of ART.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 20:28:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/797422"], "description"=>"<p>ART, antiretroviral treatment; WHO, World Health Organization; HR, hazard ratio; CI, confidence interval; PMTCT, prevention of mother to child transmission; TB, tuberculosis; AZT, zidovudine; 3TC, lamivudine; NVP, nevirapine; D4T, stavudine; EFV, efavirenz. P-values for CD4 count, WHO stage, year of initiation on ART and antiretroviral regimen are from Wald test for linear hypothesis after estimation.</p>", "links"=>[], "tags"=>["proportional", "hazards", "models", "factors", "reported"], "article_id"=>467782, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.t003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cox_proportional_hazards_models_of_factors_associated_with_mortality_after_reported_loss_to_follow_up_/467782", "title"=>"Cox proportional hazards models of factors associated with mortality after reported loss to follow-up.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 20:28:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/797466"], "description"=>"<p>ART, antiretroviral treatment; WHO, World Health Organization; HR, hazard ratio; CI, confidence interval; PMTCT, prevention of mother to child transmission; TB, tuberculosis; AZT, zidovudine; 3TC, lamivudine; NVP, nevirapine; D4T, stavudine; EFV, efavirenz. P-values for CD4 count, WHO stage, year of initiation on ART and antiretroviral regimen are from Wald test for linear hypothesis after estimation. After correction for mortality, loss to follow-up was not associated with male gender or weight anymore, while new associations emerged with higher baseline CD4 counts and pregnancy at initiation of ART.</p>", "links"=>[], "tags"=>["proportional", "hazards", "models", "factors", "follow-up", "correction"], "article_id"=>467829, "categories"=>["Medicine", "Neuroscience", "Biotechnology"], "users"=>["Gilles van Cutsem", "Nathan Ford", "Katherine Hildebrand", "Eric Goemaere", "Shaheed Mathee", "Musaed Abrahams", "David Coetzee", "Andrew Boulle"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0014684.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cox_proportional_hazards_models_of_factors_associated_with_loss_to_follow_up_before_and_after_correction_for_mortality_/467829", "title"=>"Cox proportional hazards models of factors associated with loss to follow-up before and after correction for mortality.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 20:28:39"}

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Relative Metric

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