Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis

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dc.contributor.authorVan Cutsem, Gillesen_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorHildebrand, Katherineen_ZA
dc.contributor.authorGoemaere, Ericen_ZA
dc.contributor.authorMathee, Shaheeden_ZA
dc.contributor.authorAbrahams, Musaeden_ZA
dc.contributor.authorCoetzee, Daviden_ZA
dc.contributor.authorBoulle, Andrewen_ZA
dc.date.accessioned2015-11-16T04:08:01Z
dc.date.available2015-11-16T04:08:01Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: Loss to follow-up (LTF) challenges the reporting of antiretroviral treatment (ART) programmes, since it encompasses patients alive but lost to programme and deaths misclassified as LTF. We describe LTF before and after correction for mortality in a primary care ART programme with linkages to the national vital registration system. Methods and FINDINGS: We included 6411 patients enrolled on ART between March 2001 and June 2007. Patients LTF with available civil identification numbers were matched with the national vital registration system to ascertain vital status. Corrected mortality and true LTF were determined by weighting these patients to represent all patients LTF. We used Kaplan-Meier estimates and Cox regression to describe LTF, mortality among those LTF, and true LTF. Of 627 patients LTF, 85 (28.8%) had died within 3 months after their last clinic visits. Respective estimates of LTF before and after correction for mortality were 6.9% (95% confidence interval [CI] 6.2-7.6) and 4.3% (95% CI 3.5-5.3) at one year on ART, and 23.9% (95% CI 21.0-27.2) and 19.7% (95% CI 16.1-23.7) at 5 years. After correction for mortality, the hazard of LTF was reversed from decreasing to increasing with time on ART. Younger age, higher baseline CD4 count, pregnancy and increasing calendar year were associated with higher true LTF. Mortality of patients LTF at 1, 12 and 24 months after their last visits was respectively 23.1%, 30.9% and 43.8%; 78.0% of deaths occurred during the first 3 months after last visit and 45.0% in patients on ART for 0 to 3 months. CONCLUSIONS: Mortality of patients LTF was high and occurred early after last clinic visit, especially in patients recently started on ART. Correction for these misclassified deaths revealed that the risk of true LTF increased over time. Research targeting groups at higher risk of LTF (youth, pregnant women and patients with higher CD4 counts) is needed.en_ZA
dc.identifier.apacitationVan Cutsem, G., Ford, N., Hildebrand, K., Goemaere, E., Mathee, S., Abrahams, M., ... Boulle, A. (2011). Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis. <i>PLoS One</i>, http://hdl.handle.net/11427/14983en_ZA
dc.identifier.chicagocitationVan Cutsem, Gilles, Nathan Ford, Katherine Hildebrand, Eric Goemaere, Shaheed Mathee, Musaed Abrahams, David Coetzee, and Andrew Boulle "Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/14983en_ZA
dc.identifier.citationVan Cutsem, G., Ford, N., Hildebrand, K., Goemaere, E., Mathee, S., Abrahams, M., ... & Boulle, A. (2011). Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis. PLoS One, 6(2), e14684. doi:10.1371/journal.pone.0014684en_ZA
dc.identifier.ris TY - Journal Article AU - Van Cutsem, Gilles AU - Ford, Nathan AU - Hildebrand, Katherine AU - Goemaere, Eric AU - Mathee, Shaheed AU - Abrahams, Musaed AU - Coetzee, David AU - Boulle, Andrew AB - BACKGROUND: Loss to follow-up (LTF) challenges the reporting of antiretroviral treatment (ART) programmes, since it encompasses patients alive but lost to programme and deaths misclassified as LTF. We describe LTF before and after correction for mortality in a primary care ART programme with linkages to the national vital registration system. Methods and FINDINGS: We included 6411 patients enrolled on ART between March 2001 and June 2007. Patients LTF with available civil identification numbers were matched with the national vital registration system to ascertain vital status. Corrected mortality and true LTF were determined by weighting these patients to represent all patients LTF. We used Kaplan-Meier estimates and Cox regression to describe LTF, mortality among those LTF, and true LTF. Of 627 patients LTF, 85 (28.8%) had died within 3 months after their last clinic visits. Respective estimates of LTF before and after correction for mortality were 6.9% (95% confidence interval [CI] 6.2-7.6) and 4.3% (95% CI 3.5-5.3) at one year on ART, and 23.9% (95% CI 21.0-27.2) and 19.7% (95% CI 16.1-23.7) at 5 years. After correction for mortality, the hazard of LTF was reversed from decreasing to increasing with time on ART. Younger age, higher baseline CD4 count, pregnancy and increasing calendar year were associated with higher true LTF. Mortality of patients LTF at 1, 12 and 24 months after their last visits was respectively 23.1%, 30.9% and 43.8%; 78.0% of deaths occurred during the first 3 months after last visit and 45.0% in patients on ART for 0 to 3 months. CONCLUSIONS: Mortality of patients LTF was high and occurred early after last clinic visit, especially in patients recently started on ART. Correction for these misclassified deaths revealed that the risk of true LTF increased over time. Research targeting groups at higher risk of LTF (youth, pregnant women and patients with higher CD4 counts) is needed. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0014684 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis TI - Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis UR - http://hdl.handle.net/11427/14983 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14983
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0014684
dc.identifier.vancouvercitationVan Cutsem G, Ford N, Hildebrand K, Goemaere E, Mathee S, Abrahams M, et al. Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis. PLoS One. 2011; http://hdl.handle.net/11427/14983.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular 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 Van Cutsem et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherConfidence intervalsen_ZA
dc.titleCorrecting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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