Impact of Definitions of Loss to Follow-up on Estimates of Retention, Disease Progression, and Mortality: Application to an HIV Program in Mozambique
Impact of Definitions of Loss to Follow-up on Estimates of Retention, Disease Progression, and Mortality: Application to an HIV Program in Mozambique
复制标题
DOI：
10.1093/aje/kwt030
复制
发表时间：
2013-09-01
影响因子：
5
通讯作者：
Vermund, Sten H.
中科院分区：
文献类型：
--
作者：
Shepherd, Bryan E.;Blevins, Meridith;Vermund, Sten H.
患者保留对于人类免疫缺陷病毒（HIV）等慢性疾病的管理至关重要;因此，准确测量失访（LTF）非常重要。已经提出了许多不同的LTF定义。在2006年至2011年期间在莫桑比克开始抗逆转录病毒治疗的9，692名HIV感染患者的队列中，我们通过应用从HIV文献中收集的17种不同的LTF定义来研究LTF定义对LTF估计率、获得性免疫缺陷综合征（AIDS）定义事件和死亡的影响。我们进一步研究了LTF定义的4个特定组成部分的影响。通过将死亡视为竞争风险来估计LTF和AIDS定义事件的累积发生率;使用Kaplan-Meier技术和变异来估计死亡率，以解释信息性删失。治疗开始后2年的LTF估计值很高，并且变化很大，从22%到84%，取决于所使用的LTF定义。2年死亡率估计值从11%到16%不等，2年艾滋病定义事件估计值从6%到8%不等。如图所示，LTF定义的选择会极大地影响研究结论和项目评估。LTF定义的选择应基于研究结果、临床接触的可用数据和患者的访视时间表;我们提出了一些一般性指南。
Patient retention is critical to the management of chronic diseases such as human immunodeficiency virus (HIV); hence, accurate measures of loss to follow-up (LTF) are important. Many different LTF definitions have been proposed. In a cohort of 9,692 HIV-infected patients initiating antiretroviral therapy in Mozambique from 2006 to 2011, we investigated the impact of the definition of LTF on estimated rates of LTF, acquired immunodeficiency syndrome (AIDS)-defining events, and death by applying 17 different definitions of LTF gleaned from HIV literature. We further investigated the impact of 4 specific components of the LTF definitions. Cumulative incidences of LTF and AIDS-defining events were estimated by treating death as a competing risk; Kaplan-Meier techniques and variations to account for informative censoring were used to estimate rates of mortality. Estimates of LTF 2 years after treatment initiation were high and varied substantially, from 22% to 84% depending on the LTF definition used. Estimates of 2-year mortality varied from 11% to 16%, and estimates of 2-year AIDS-defining events varied from 6% to 8%. As seen here, the choice of LTF definition can greatly affect study conclusions and program evaluations. Selection of LTF definitions should be based on the study outcome, available data on clinical encounters, and the patients' visit schedules; we suggest some general guidelines.