Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America

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dc.contributor.authorChi, Benjamin Hen_ZA
dc.contributor.authorYiannoutsos, Constantin Ten_ZA
dc.contributor.authorWestfall, Andrew Oen_ZA
dc.contributor.authorNewman, Jamie Een_ZA
dc.contributor.authorZhou, Jialunen_ZA
dc.contributor.authorCesar, Carinaen_ZA
dc.contributor.authorBrinkhof, Martin W Gen_ZA
dc.contributor.authorMwango, Alberten_ZA
dc.contributor.authorBalestre, Ericen_ZA
dc.contributor.authorCarriquiry, Gabrielaen_ZA
dc.date.accessioned2016-01-02T05:08:39Z
dc.date.available2016-01-02T05:08:39Z
dc.date.issued2011en_ZA
dc.description.abstractBackground: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. Methods and Findings: At a set ''status classification'' date, patients were categorized as either ''active'' or ''LTFU'' according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities - representing 180,718 patients from 19 countries - were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173–181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%–7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean = 150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean = 1.2%, 95% CI: 1.0%–1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean = 19.9%, 95% CI: 19.1%–21.7%). Conclusions: Based on this evaluation, we recommend the adoption of $180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide.en_ZA
dc.identifier.apacitationChi, B. H., Yiannoutsos, C. T., Westfall, A. O., Newman, J. E., Zhou, J., Cesar, C., ... Carriquiry, G. (2011). Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America. <i>PLOS Medicince</i>, http://hdl.handle.net/11427/16186en_ZA
dc.identifier.chicagocitationChi, Benjamin H, Constantin T Yiannoutsos, Andrew O Westfall, Jamie E Newman, Jialun Zhou, Carina Cesar, Martin W G Brinkhof, Albert Mwango, Eric Balestre, and Gabriela Carriquiry "Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America." <i>PLOS Medicince</i> (2011) http://hdl.handle.net/11427/16186en_ZA
dc.identifier.citationChi, B. H., Yiannoutsos, C. T., Westfall, A. O., Newman, J. E., Zhou, J., Cesar, C., ... & Sirisanthana, T. (2011). Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America. PLoS medicine, 8(10), e1001111. doi:10.1371/journal.pmed.1001111en_ZA
dc.identifier.ris TY - Journal Article AU - Chi, Benjamin H AU - Yiannoutsos, Constantin T AU - Westfall, Andrew O AU - Newman, Jamie E AU - Zhou, Jialun AU - Cesar, Carina AU - Brinkhof, Martin W G AU - Mwango, Albert AU - Balestre, Eric AU - Carriquiry, Gabriela AB - Background: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. Methods and Findings: At a set ''status classification'' date, patients were categorized as either ''active'' or ''LTFU'' according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities - representing 180,718 patients from 19 countries - were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173–181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%–7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean = 150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean = 1.2%, 95% CI: 1.0%–1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean = 19.9%, 95% CI: 19.1%–21.7%). Conclusions: Based on this evaluation, we recommend the adoption of $180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pmed.1001111 DP - University of Cape Town J1 - PLOS Medicince LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America TI - Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America UR - http://hdl.handle.net/11427/16186 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16186
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pmed.1001111
dc.identifier.vancouvercitationChi BH, Yiannoutsos CT, Westfall AO, Newman JE, Zhou J, Cesar C, et al. Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America. PLOS Medicince. 2011; http://hdl.handle.net/11427/16186.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2011 Chi et al.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLOS Medicinceen_ZA
dc.source.urihttp://journals.plos.org/plosmedicineen_ZA
dc.subject.otherAIDSen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherAfricaen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherAdultsen_ZA
dc.subject.otherAsiaen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.titleUniversal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin Americaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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