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

Anderegg, Nanina; Hector, Jonas; Jefferys, Laura F; Burgos-Soto, Juan; Hobbins, Michael A; Ehmer, Jochen; Meier, Lukas; Maathuis, Marloes H; Egger, Matthias (2020). Loss to follow-up correction increased mortality estimates in HIV-positive people on antiretroviral therapy in Mozambique. Journal of clinical epidemiology, 128, pp. 83-92. Elsevier 10.1016/j.jclinepi.2020.08.012

[img]
Preview
Text
Anderegg JClinEpidemiol 2020_AAM.pdf - Accepted Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (2MB) | Preview
[img] Text
Anderegg_JClinEpidemiol_2020.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

OBJECTIVES

People living with HIV (PLWH) 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 analysed 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 [ML], Ridge regression or Bayesian model averaging [BMA]). We fitted competing risk models to identify risk factors for death and LTFU.

RESULTS

Analyses included 4492 patients; during 8152 person-years of follow-up, 486 patients died, 2375 were LTFU, 752 were traced, and 603 were found. At 4 years after starting ART, observed mortality was 11.9% (95% CI 10.9-13.0) but 23.5% (19.8- 28.0), 21.6% (18.7-25.0) and 23.3% (19.7-27.6) after correction with ML, Ridge and BMA weights, respectively. Risk factors for death included male sex, lower CD4 cell counts and more advanced clinical stage.

CONCLUSION

In ART programmes with substantial LTFU, mortality estimates need to take LTFU into account.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Anderegg, Nanina Tamar and Egger, Matthias

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0895-4356

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

01 Sep 2020 18:00

Last Modified:

21 Aug 2021 02:30

Publisher DOI:

10.1016/j.jclinepi.2020.08.012

PubMed ID:

32828836

Uncontrolled Keywords:

AIDS HIV Loss to follow-up Mozambique highly active antiretroviral therapy mortality

BORIS DOI:

10.7892/boris.146267

URI:

https://boris.unibe.ch/id/eprint/146267

Actions (login required)

Edit item Edit item
Provide Feedback