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

项目摘要(摘要) 在拉丁美洲，艾滋病毒仍然是一个巨大的公共卫生挑战，有近180万成年人感染艾滋病毒 该区域低收入和中等收入环境中的艾滋病毒问题。为了识别关键风险群体并部署相关的 干预措施结束艾滋病毒流行，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极好数据来源，但只能提供 对持续投入和各种临床结果的不完美测量，因为后续的损失- Up(LTFU)。在特定临床队列地点失去随访的个人似乎已经从 数据点，但实际上可能会经历静默转移(其中患者在没有通知的情况下切换诊所)， 护理方面的真正差距(即患者确实停止了医疗护理)，或者是未被观察到的致命事件。 像世界卫生组织(WHO)这样的组织目前使用事后分析方法来纠正 LTFU，但没有拉丁美洲的修正系数。因此，世卫组织目前正在申请 估计从撒哈拉以南非洲到拉丁美洲，那里的人口可能非常不同。 我们建议通过临床和生命之间的联系来衡量失落人群的临床和生命结局 数据来源和完善的州/省或国家登记处。这种注册表链接的跟踪策略 对于可能已经是资源的临床站点来说，具有相对低成本和低工作量的好处- 受约束。由此修订的LTFU估计可能会改善交战结果的衡量， 从这些设置中减少研究中潜在的选择偏差和错误分类错误，并通知双方 研究人员和公共卫生利益攸关方。 加勒比、中美洲和南美洲艾滋病毒流行病学网络是拉丁美洲的 这是最大的艾滋病毒观察队列，为开展这项工作提供了丰富的数据来源。几个 参与的队列地点位于拥有强大的公共卫生基础设施的国家，包括可靠的 药房、实验室和生命状态登记处或监视系统。事实上，其中几个网站是 目前正在与各自的卫生部开展登记联系活动。CCASAnet还拥有 在开展协作研究项目以解决护理和风险方面的参与度方面拥有丰富的经验- 定义人口的相关因素。这项研究的目标1将提高患者死亡率和结果确定 通过与CCASAnet网站的药房、实验室和生命状况登记处建立联系，并与可用的区域 和国家登记处。这项研究的目标2将是复制亚太区域协调委员会的区域分析 患者死亡率和LTFU数据并报告结果以及巴西的最佳登记搜索战略， 墨西哥和秘鲁。

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.