Gone But Not Lost: Implications for Estimating HIV Care Outcomes When Loss to Clinic Is Not Loss to Care.
Gone But Not Lost: Implications for Estimating HIV Care Outcomes When Loss to Clinic Is Not Loss to Care.
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消失但不会丢失：当损失诊所的损失不是护理时，估计艾滋病毒护理结果的影响。
DOI：
10.1097/ede.0000000000001201
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发表时间：
2020-07
期刊：
影响因子：
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通讯作者：
Edmonds A
中科院分区：
文献类型：
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作者：
Edwards JK;Lesko CR;Herce ME;Murenzi G;Twizere C;Lelo P;Anastos K;Tymejczyk O;Yotebieng M;Nash D;Adedimeji A;Edmonds A
在一些事件发生时间分析中，尚不清楚是否应将失访视为审查事件或竞争事件。这种模糊性在艾滋病毒研究中尤其常见，艾滋病毒研究使用常规收集的临床数据来报告艾滋病毒护理连续过程中关键里程碑的时间安排。在这种情况下，失访可能被视为审查事件，假设从研究诊所“失访”的患者立即在其他地方接受护理，或者是竞争事件，假设“失访”的患者全部都脱离了护理。我们在估计 2006 年至 2017 年间参加 IeDEA 中部非洲队列的 19,506 名艾滋病毒感染者的 2 年开始抗逆转录病毒治疗的风险时，阐述了解决这一模糊性的方法，并结合非洲追踪研究已发表的估计值。我们还使用模拟实验评估了所提出方法的有限样本属性。如果患者因失访而被审查，则预计 2 年开始治疗的风险为 69%；如果失访被视为竞争事件，则为 59%。使用所提出的方法，我们估计开始 ART 的 2 年风险为 62%（95% 置信区间：61、62）。在模拟实验中检查的场景下，所提出的方法具有很小的偏差和适当的置信区间覆盖范围。所提出的方法放宽了将失访视为临床艾滋病队列研究中的审查或竞争事件的固有假设。
In some time-to-event analyses, it is unclear whether loss to follow-up should be treated as a censoring event or a competing event. Such ambiguity is particularly common in HIV research that uses routinely collected clinical data to report the timing of key milestones along the HIV care continuum. In this setting, loss to follow-up may be viewed as a censoring event, under the assumption that patients who are “lost” from a study clinic immediately enroll in care elsewhere, or a competing event, under the assumption that people “lost” are out of care all together. We illustrate an approach to address this ambiguity when estimating the 2-year risk of antiretroviral treatment initiation among 19,506 people living with HIV who enrolled in the IeDEA Central Africa cohort between 2006 and 2017, along with published estimates from tracing studies in Africa. We also assessed the finite sample properties of the proposed approach using simulation experiments. The estimated 2-year risk of treatment initiation was 69% if patients were censored at loss to follow-up or 59% if losses to follow-up were treated as competing events. Using the proposed approach, we estimated that the 2-year risk of ART initiation was 62% (95% confidence interval: 61, 62). The proposed approach had little bias and appropriate confidence interval coverage under scenarios examined in the simulation experiments. The proposed approach relaxes the assumptions inherent in treating loss to follow-up as a censoring or competing event in clinical HIV cohort studies.