Using vital registration data to update mortality among patients lost to follow-up from ART programmes: evidence from the Themba Lethu Clinic, South Africa.
Using vital registration data to update mortality among patients lost to follow-up from ART programmes: evidence from the Themba Lethu Clinic, South Africa.
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DOI：
10.1111/j.1365-3156.2010.02473.x
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发表时间：
2010-04
期刊：
影响因子：
--
通讯作者：
Sanne I
中科院分区：
文献类型：
--
作者：
Fox MP;Brennan A;Maskew M;MacPhail P;Sanne I
估计南非一家大型公共部门艾滋病毒诊所失去随访(LTFU)患者的死亡率。我们使用诊所的数据库将生命状态与南非内政部的生命登记系统验证的生命状态进行了比较。我们比较了更新死亡率数据前后的死亡率。使用Kaplan-Meier曲线和比例风险回归估计死亡率的预测因素。在截至2008年10月1日在LTC启动HAART的7097名患者中，6205名患者有ID号。2453例患者(21%)为LTFU，其中1037例(42.3%)可纳入分析。在与生命登记系统匹配后，死亡率增加了一倍多，从4.2%(258/6205)增加到10.0%(623/6205)。寿命表分析显示，LTFU消失1、2、3年的生存概率分别为69.2%(95%可信区间：66.3%~72%)、64.2%(95%可信区间：61%~67%)和58.7%(95%可信区间：55%~62%)。死亡后死亡风险最高的患者是有肺结核病史、CD4100cell/μL、体重17.5、血红蛋白10.0及接受治疗6个月的患者。尽管积极追踪有限，但在南非艾滋病毒治疗计划中失去的患者的死亡率被大大低估。与生命登记系统的联系可以提供对计划有效性的更准确评估，并针对最有可能死亡的失踪患者。
To estimate the rates of mortality in patients lost to follow up (LTFU) from a large urban public sector HIV clinic in South Africa. We compared vital status using the clinic’s database to vital status verified against the Vital Registration system at the South African Department of Home Affairs. We compared rates of mortality before and after updating mortality data. Predictors of mortality were estimated using Kaplan-Meier curves and proportional hazard regression. Of the 7,097 total patients who initiated HAART at LTC by October 1st, 2008 and had an ID number, 6205 were included. 2453 patients (21%) were LTFU, of whom 1037 (42.3%) could be included in the analysis. After matching to the vital registration system, mortality more than doubled from 4.2% (258/6205) to 10.0% (623/6205). By life-table analysis the probability of survival amongst those LTFU was 69.2% (95% CI: 66.3%–72%), 64.2% (95% CI: 61%–67%) and 58.7% (95% CI: 55%–62%) by years 1, 2 and 3 since being lost, respectively. Those at highest risk of death after being lost were patients with a history of tuberculosis, CD4 count <100 cells/μL, BMI <17.5, hemoglobin <10 and on <6 months of treatment. Mortality was substantially underestimated among patients lost from a South African HIV treatment program despite limited active tracing. Linking to vital registration systems can provide more accurate assessments of program effectiveness and target lost patients most at risk for mortality.
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影响因子：
15.8
作者：
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