Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis.
Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis.
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DOI：
10.1371/journal.pone.0014684
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发表时间：
2011-02-17
期刊：
影响因子：
3.7
通讯作者：
Boulle A
中科院分区：
文献类型：
--
作者：
Van Cutsem G;Ford N;Hildebrand K;Goemaere E;Mathee S;Abrahams M;Coetzee D;Boulle A
失访 (LTF) 对抗逆转录病毒治疗 (ART) 计划的报告提出了挑战，因为它包括存活但失访的患者以及被错误分类为 LTF 的死亡。我们描述了初级保健 ART 计划中死亡率校正前后的 LTF，并与国家人口动态登记系统相联系。我们纳入了 2001 年 3 月至 2007 年 6 月期间登记参加 ART 的 6411 名患者。将具有可用公民身份证号码的患者 LTF 与国家人口动态登记系统进行匹配，以确定人口动态状况。通过对这些患者进行加权以代表所有患者的 LTF 来确定校正死亡率和真实 LTF。我们使用 Kaplan-Meier 估计和 Cox 回归来描述 LTF、这些 LTF 中的死亡率以及真实的 LTF。在 627 名 LTF 患者中，85 名 (28.8%) 在最后一次就诊后 3 个月内死亡。死亡率校正前后的 LTF 估计值在 ART 治疗一年时分别为 6.9%（95% CI 6.2-7.6）和 4.3%（95% CI 3.5-5.3），5 年时分别为 23.9%（95% CI 21.0-27.2）和 19.7%（95% CI 16.1-23.7）。校正死亡率后，随着 ART 治疗时间的延长，LTF 的风险从降低变为增加。年龄较小、基线 CD4 计数较高、怀孕和日历年数增加与较高的真实 LTF 相关。 LTF患者末次就诊后1、12和24个月的死亡率分别为23.1%、30.9%和43.8%； 78.0% 的死亡发生在最后一次就诊后的前 3 个月内，45.0% 的死亡发生在接受 ART 0 至 3 个月的患者中。 LTF 患者的死亡率很高，并且发生在上次就诊后的早期，尤其是最近开始接受 ART 的患者。对这些错误分类的死亡进行纠正后发现，真正的 LTF 风险随着时间的推移而增加。需要针对 LTF 风险较高的群体（青少年、孕妇和 CD4 计数较高的患者）开展研究。
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. 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. 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.
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DOI：
10.1097/qad.0b013e32833d45c5
发表时间：
2010-09-10
期刊：
AIDS (London, England)
影响因子：
--
作者：
Cornell M;Grimsrud A;Fairall L;Fox MP;van Cutsem G;Giddy J;Wood R;Prozesky H;Mohapi L;Graber C;Egger M;Boulle A;Myer L;International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
影响因子：
6.4
作者：
Bedelu, Martha;Ford, Nathan;Reuter, Hermann
通讯作者：
Reuter, Hermann
DOI：
10.2471/blt.07.044248
发表时间：
2008-07-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Brinkhof, Martin WG;Dabis, François;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
3.8
作者：
Oyugi, Jessica H.;Byakika-Tusiime, Jayne;Bangsberg, David R.
通讯作者：
Bangsberg, David R.
影响因子：
3.8
作者：
Coetzee, D;Hildebrand, K;Goemaere, E
通讯作者：
Goemaere, E