Tracking a sample of patients lost to follow-up has a major impact on understanding determinants of survival in HIV-infected patients on antiretroviral therapy in Africa.
Tracking a sample of patients lost to follow-up has a major impact on understanding determinants of survival in HIV-infected patients on antiretroviral therapy in Africa.
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DOI：
10.1111/j.1365-3156.2010.02507.x
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发表时间：
2010-06
期刊：
影响因子：
--
通讯作者：
Martin JN
中科院分区：
文献类型：
--
作者：
Geng EH;Glidden DV;Emenyonu N;Musinguzi N;Bwana MB;Neilands TB;Muyindike W;Yiannoutsos CT;Deeks SG;Bangsberg DR;Martin JN
迄今为止，关于非洲开始抗逆转录病毒疗法的艾滋病毒感染者死亡率决定因素的数据主要来自实行“公共卫生办法”的常规临床护理机构。然而，在这些情况下，失访率很高，可能导致对死亡率决定因素的理解出现偏差。我们评估了2004年1月1日至2007年9月30日在乌干达西南部的一家ART诊所开始ART治疗的HIV感染成人。通过常规临床护理获得临床和人口统计学特征。在评估死亡率的决定因素时，“简单”分析仅使用通过常规程序已知的死亡人数。一个“样本校正”的方法，通过概率权重，结果从一个代表性的样本失访的病人，其生命状态是通过在社区跟踪确定。在3,628名患者中，在ART开始后随访长达3.75年，“幼稚”方法将男性性别和较低的ART前CD 4计数确定为死亡率的独立决定因素。“样本校正”方法发现，较低的抗逆转录病毒治疗前的CD 4计数，年龄较大，体重较轻和日历年的抗逆转录病毒治疗开始，但不是男性，是死亡率的独立决定因素。为确定非洲接受抗逆转录病毒疗法的艾滋病毒感染者死亡率的决定因素而进行的分析，如果不考虑失访，可能会发现虚假的关联，而忽略实际的关系-两者都有可能误导公共卫生工作。以抽样为基础的方法来说明后续损失是一种可行的和潜在的可扩展的方法，以加强非洲实施抗逆转录病毒治疗的证据。
To date, data regarding the determinants of mortality in HIV-infected patients starting antiretroviral therapy (ART) in Africa have been primarily derived from routine clinical care settings practicing the “public health approach.” Losses to follow-up, however, are high in these settings and may lead to bias in understanding the determinants of mortality. We evaluated HIV-infected adults initiating ART between January 1, 2004 and September 30, 2007 in an ART clinic in southwestern Uganda. Clinical and demographic characteristics were obtained through routine clinical care. In evaluating determinants of mortality, a “naïve” analysis used only deaths known through routine processes. A “sample-corrected” approach incorporated, through probability weights, outcomes from a representative sample of patients lost to follow-up whose vital status was ascertained through tracking in the community. In 3,628 patients followed for up to 3.75 years after ART initiation, the “naïve” approach identified male sex and lower pre-ART CD4 count as independent determinants of mortality. The “sample-corrected” approach found lower pre-ART CD4 count, older age, lower weight and calendar year of ART initiation, but not male sex, to be independent determinants of mortality. Analyses to identify determinants of mortality in HIV-infected patients on ART in Africa that do not account for losses to follow-up can identify spurious associations and miss actual relationships – both with the potential to mislead public health efforts. A sampling-based approach to account for losses to follow-up represents a feasible and potentially scalable method to strengthen the evidence available for implementation of ART delivery in Africa.
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