Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis.
Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis.
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DOI：
10.1093/cid/ciy347
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发表时间：
2018-11-13
期刊：
影响因子：
--
通讯作者：
Egger M
中科院分区：
文献类型：
--
作者：
Chammartin F;Zürcher K;Keiser O;Weigel R;Chu K;Kiragga AN;Ardura-Garcia C;Anderegg N;Laurent C;Cornell M;Tweya H;Haas AD;Rice BD;Geng EH;Fox MP;Hargreaves JR;Egger M
在非洲，抗逆转录病毒药物的滞留令人关切。我们分析了失访患者的结局：在最后一次接触后4年，22%死亡，23%停止治疗，15%在另一家诊所，32%无法找到。联合抗逆转录病毒治疗（cART）的低保留率已成为联合国人类免疫缺陷病毒（HIV）/艾滋病联合规划署（UNAIDS）90 - 90 - 90目标的威胁。我们检查了在非洲治疗项目中开始cART但随后失访（LTFU）的患者的结局。这是一项系统性综述和对追踪LTFU患者的研究进行的个体患者数据荟萃分析。使用累积发生率函数和比例风险模型分析结局，以确定（i）死亡、（ii）存活但停止cART、（iii）无症状转移至其他诊所和（iv）保留cART的竞争风险。9项研究提供了撒哈拉以南非洲7377例开始cART并随后接受LTFU的患者的数据。cART开始时的中位CD4计数为129个细胞/μ L。末次门诊访视后4年，21.8%（95%置信区间[CI]，20.8%-22.7%）已知死亡，22.6%（95% CI，21.6%-23.6%）存活但已停止cART，14.8%（95% CI，14.0%-15.6%）转移到另一家诊所，9.2%（95% CI，8.5%-9.8%）保留在cART，31.6%（95% CI，30.6%-32.7%）。死亡率与男性、更晚期的疾病和更短的cART持续时间相关;停止cART，疾病较轻，cART持续时间较长;女性和疾病较轻的沉默转移。在对撒哈拉以南非洲地区的项目成果和联合国艾滋病规划署目标进行公正评估时，必须考虑患者的死亡率。应优先考虑立即开始cART和早期追踪患者LTFU。
Retention on antiretrovirals is of concern in Africa. We analyzed outcomes in patients lost to follow-up: at 4 years after last contact, 22% had died, 23% had stopped therapy, 15% were in another clinic, and 32% could not be found. Low retention on combination antiretroviral therapy (cART) has emerged as a threat to the Joint United Nations Programme on human immunodeficiency virus (HIV)/AIDS (UNAIDS) 90-90-90 targets. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African treatment programs. This was a systematic review and individual patient data meta-analysis of studies that traced patients who were LTFU. Outcomes were analyzed using cumulative incidence functions and proportional hazards models for the competing risks of (i) death, (ii) alive but stopped cART, (iii) silent transfer to other clinics, and (iv) retention on cART. Nine studies contributed data on 7377 patients who started cART and were subsequently LTFU in sub-Saharan Africa. The median CD4 count at the start of cART was 129 cells/μL. At 4 years after the last clinic visit, 21.8% (95% confidence interval [CI], 20.8%–22.7%) were known to have died, 22.6% (95% CI, 21.6%–23.6%) were alive but had stopped cART, 14.8% (95% CI, 14.0%–15.6%) had transferred to another clinic, 9.2% (95% CI, 8.5%–9.8%) were retained on cART, and 31.6% (95% CI, 30.6%–32.7%) could not been found. Mortality was associated with male sex, more advanced disease, and shorter cART duration; stopping cART with less advanced disease andlonger cART duration; and silent transfer with female sex and less advanced disease. Mortality in patients LTFU must be considered for unbiased assessments of program outcomes and UNAIDS targets in sub-Saharan Africa. Immediate start of cART and early tracing of patients LTFU should be priorities.
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影响因子：
2.3
作者：
Bartlett JW;Seaman SR;White IR;Carpenter JR;Alzheimer's Disease Neuroimaging Initiative*
通讯作者：
Alzheimer's Disease Neuroimaging Initiative*
DOI：
10.1097/qai.0000000000000553
发表时间：
2015-05-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Fox MP;Rosen S
通讯作者：
Rosen S
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
DOI：
10.1097/ftd.0b013e3182526e6a
发表时间：
2012-06-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Alamo ST;Colebunders R;Ouma J;Sunday P;Wagner G;Wabwire-Mangen F;Laga M
通讯作者：
Laga M
影响因子：
3.7
作者：
Henriques J;Pujades-Rodriguez M;McGuire M;Szumilin E;Iwaz J;Etard JF;Ecochard R
通讯作者：
Ecochard R