Registry Linkage to Improve Mortality Ascertainment and Assessment of Engagement in Care in Brazil, Mexico, and Peru

项目概要（摘要） 艾滋病毒仍然是拉丁美洲的一个巨大的公共卫生挑战，有近 180 万成年人感染艾滋病毒 该地区低收入和中等收入环境中的艾滋病毒。为了识别关键风险群体并部署相关 结束艾滋病毒流行的干预措施、研究人员和公共卫生组织需要高质量的数据 关于患者在临床护理中的保留、抗逆转录病毒治疗 (ART) 的使用和死亡率估计。临床 队列是衡量护理质量和频率的绝佳数据源，但只能提供 由于失去后续服务，对持续参与和各种临床结果的测量不完美 上（LTFU）。在特定临床队列地点失访的个体似乎已经从临床队列中“消失”了。 数据点，但实际上可能会经历无声转移（患者在没有通知的情况下更换诊所）， 真正的护理差距（患者真正停止医疗护理），或未观察到的致命事件。 世界卫生组织（WHO）等组织目前使用事后分析方法来纠正 LTFU，但拉丁美洲没有可用的修正系数。因此，世界卫生组织目前正在申请 从撒哈拉以南非洲到拉丁美洲的估计，那里的人口可能有很大差异。 我们建议通过临床之间的联系来衡量流失人群的临床和重要结果 数据源和完善的州/省或国家登记处。这种注册表链接的追踪策略 对于可能已经资源匮乏的临床场所来说，其优点是成本相对较低，工作量也较小。 受到限制。由此产生的 LTFU 修订估计可以改善参与结果测量， 减少这些设置中研究中潜在的选择偏差和错误分类错误，并告知两者 研究人员和公共卫生利益相关者。 加勒比、中南美洲艾滋病毒流行病学网络 (CCASAnet) 是拉丁美洲的 最大的观察性艾滋病毒队列，并为开展这项工作提供了丰富的数据源。几个 参与队列地点位于公共卫生基础设施健全的国家，包括可靠的 药房、实验室和生命状态登记或监测系统。事实上，其中有几个网站 目前正从事与各自卫生部的登记联系活动。 CCASAnet还有 开展合作研究项目的丰富经验，解决参与护理和风险的问题 人口定义相关性。本研究的目标 1 将提高患者死亡率和结果确定 通过与 CCASAnet 站点上的药房、实验室和生命状态登记处的链接，并提供可用的区域信息 和国家登记处。本研究的目标 2 将是使用修订后的 CCASAnet 区域分析来重复 巴西患者死亡率和 LTFU 数据和报告结果以及最佳注册搜索策略， 墨西哥、秘鲁。

PROJECT SUMMARY (ABSTRACT) HIV remains a massive public health challenge in Latin America, with nearly 1.8 million adults living with HIV in the region's low- and middle-income settings. In order to identify key risk groups and deploy relevant interventions to end the HIV epidemic, researchers and public health organizations need high quality data regarding patient retention in clinical care, antiretroviral therapy (ART) use, and mortality estimates. Clinical cohorts are an excellent data source for measuring the quality and frequency of care, but can provide only imperfect measurements of sustained engagement and various clinical outcomes because of losses to follow- up (LTFU). Individuals lost to follow-up at particular clinical cohort sites appear to have “disappeared” from the point of the data, but may in fact experience silent transfers (wherein patients switch clinics without notice), true gaps in care (wherein patients have truly discontinued medical care), or an unobserved fatal event. Groups like the World Health Organization (WHO) currently use post hoc analytic approaches to correct for LTFU, but no correction factors are available for Latin America. As a result, the WHO is currently applying estimates from sub-Saharan Africa to Latin America, where the populations may be very different. We propose to measure clinical and vital outcomes in the lost population through linkages between clinical data sources and well-established state/provincial or national registries. This tracing strategy of registry linkage has the benefit of being relatively low-cost and low-effort for clinical sites that may already be resource- constrained. The resulting revised estimates of LTFU could improve engagement outcome measurements, reduce potential selection bias and misclassification errors in research from these settings, and inform both researchers and public health stakeholders. The Caribbean, Central and South America network for HIV epidemiology (CCASAnet) is Latin America's largest observational HIV cohort and provides a rich data source in which to conduct this work. Several participating cohort sites are located in countries with robust public health infrastructure, including reliable pharmacy, laboratory, and vital status registries or surveillance systems. In fact, several of these sites are currently engaged in registry linkage activities with their respective health ministries. CCASAnet also has extensive experience conducting collaborative research projects addressing engagement in care and risk- population-defining correlates. Aim 1 of this study will improve patient mortality and outcome ascertainment through linkage to pharmacy, laboratory, and vital status registries at CCASAnet sites with available regional and national registries. Aim 2 of this study will be to replicate CCASAnet regional analyses using revised patient mortality and LTFU data and report findings along with optimal registry search strategies for Brazil, Mexico, and Peru.