Nanina Anderegg1, Jonas Hector2, Laura F Jefferys2, Juan Burgos-Soto2, Michael A Hobbins3, Jochen Ehmer3, Lukas Meier4, Marloes H Maathuis4, Matthias Egger5. 1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. Electronic address: nanina.anderegg@ispm.unibe.ch. 2. SolidarMed, Ancuabe, Mozambique. 3. SolidarMed, Lucerne, Switzerland. 4. Seminar for Statistics, ETH Zürich, Zürich, Switzerland. 5. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Abstract
OBJECTIVES: People living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART) may be lost to follow-up (LTFU), which hampers the assessment of outcomes. We estimated mortality for patients starting ART in a rural region in sub-Saharan Africa and examined risk factors for death, correcting for LTFU. STUDY DESIGN AND SETTING: We analyzed data from Ancuabe, Mozambique, where patients LTFU are traced by phone and home visits. We used cumulative incidence functions to estimate mortality and LTFU. To correct for LTFU, we revised outcomes based on tracing data using different inverse probability weights (maximum likelihood, Ridge regression, or Bayesian model averaging). We fitted competing risk models to identify risk factors for death and LTFU. RESULTS: The analyses included 4,492 patients; during 8,152 person-years of follow-up, 486 patients died, 2,375 were LTFU, 752 were traced, and 603 were found. At 4 years after starting ART, observed mortality was 11.9% (95% confidence interval [CI]: 10.9-13.0), but 23.5% (95% CI: 19.8-28.0), 21.6% (95% CI: 18.7-25.0), and 23.3% (95% CI: 19.7-27.6) after correction with maximum likelihood, Ridge regression, and Bayesian model averaging weights, respectively. The risk factors for death included male sex, lower CD4 cell counts, and more advanced clinical stage. CONCLUSION: In ART programs with substantial LTFU, mortality estimates need to take LTFU into account.
OBJECTIVES:People living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART) may be lost to follow-up (LTFU), which hampers the assessment of outcomes. We estimated mortality for patients starting ART in a rural region in sub-Saharan Africa and examined risk factors for death, correcting for LTFU. STUDY DESIGN AND SETTING: We analyzed data from Ancuabe, Mozambique, where patients LTFU are traced by phone and home visits. We used cumulative incidence functions to estimate mortality and LTFU. To correct for LTFU, we revised outcomes based on tracing data using different inverse probability weights (maximum likelihood, Ridge regression, or Bayesian model averaging). We fitted competing risk models to identify risk factors for death and LTFU. RESULTS: The analyses included 4,492 patients; during 8,152 person-years of follow-up, 486 patientsdied, 2,375 were LTFU, 752 were traced, and 603 were found. At 4 years after starting ART, observed mortality was 11.9% (95% confidence interval [CI]: 10.9-13.0), but 23.5% (95% CI: 19.8-28.0), 21.6% (95% CI: 18.7-25.0), and 23.3% (95% CI: 19.7-27.6) after correction with maximum likelihood, Ridge regression, and Bayesian model averaging weights, respectively. The risk factors for death included male sex, lower CD4 cell counts, and more advanced clinical stage. CONCLUSION: In ART programs with substantial LTFU, mortality estimates need to take LTFU into account.
Authors: Nanina Anderegg; Leigh F Johnson; Elizabeth Zaniewski; Keri N Althoff; Eric Balestre; Matthew Law; Denis Nash; Bryan E Shepherd; Constantin T Yiannoutsos; Matthias Egger Journal: AIDS Date: 2017-04 Impact factor: 4.177
Authors: Elvin H Geng; Mwebesa B Bwana; Winnie Muyindike; David V Glidden; David R Bangsberg; Torsten B Neilands; Ingrid Bernheimer; Nicolas Musinguzi; Constantin T Yiannoutsos; Jeffrey N Martin Journal: J Acquir Immune Defic Syndr Date: 2013-06-01 Impact factor: 3.731
Authors: Constantin Theodore Yiannoutsos; Leigh Francis Johnson; Andrew Boulle; Beverly Sue Musick; Thomas Gsponer; Eric Balestre; Matthew Law; Bryan E Shepherd; Matthias Egger Journal: Sex Transm Infect Date: 2012-12 Impact factor: 3.519
Authors: Maria Ruano Camps; Paula E Brentlinger; Gerito Augusto; Alexandre Nguimfack; Florindo Mudender Journal: J Int Assoc Provid AIDS Care Date: 2017-05-31
Authors: Elizabeth Zaniewski; Ellen Brazier; Cam Ha Dao Ostinelli; Robin Wood; Meg Osler; Karl-Günter Technau; Joep J van Oosterhout; Nicola Maxwell; Janneke van Dijk; Hans Prozesky; Matthew P Fox; Jacob Bor; Denis Nash; Matthias Egger Journal: J Clin Epidemiol Date: 2021-09-03 Impact factor: 6.437
Authors: Paul Y Wada; Ahra Kim; Karu Jayathilake; Stephany N Duda; Yao Abo; Keri N Althoff; Morna Cornell; Beverly Musick; Steve Brown; Annette H Sohn; Yu Jiun Chan; Kara K Wools-Kaloustian; Denis Nash; Constantin T Yiannoutsos; Carina Cesar; Catherine C McGowan; Peter F Rebeiro Journal: AIDS Patient Care STDS Date: 2022-08-26 Impact factor: 5.944
Authors: Alan R Lifson; Abera Hailemichael; Sale Workneh; Richard F MacLehose; Keith J Horvath; Rose Hilk; Anne Sites; Lucy Slater; Tibebe Shenie Journal: AIDS Care Date: 2022-02-23
Authors: Marie Ballif; Benedikt Christ; Nanina Anderegg; Frédérique Chammartin; Josephine Muhairwe; Laura Jefferys; Jonas Hector; Janneke van Dijk; Michael J Vinikoor; Monique van Lettow; Cleophas Chimbetete; Sam J Phiri; Dorina Onoya; Matthew P Fox; Matthias Egger Journal: Clin Infect Dis Date: 2022-01-29 Impact factor: 9.079