Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: Study protocol

Christ, Benedikt; Ballif, Marie; Anderegg, Nanina; Chammartin, Frédérique; Zürcher, Kathrin; Michel, Janet; Muhairwe, Josephine; Jefferys, Laura; Hector, Jonas; Dijk, Janneke H. van; Vinikoor, Michael J.; Lettow, Monique van; Chimbetete, Cleophas; Phiri, Sam; Onoya, Dorina; Fox, Matthew P.; Egger, Matthias

doi:10.31219/osf.io/52tk8

Cited by 4 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mortality rates in 2017 were an average 60% and 73% lower than in 2005, in and outside of Africa, respectively, after controlling for individual characteristics, and with some variation by age, region and ART duration. However, our adjusted analysis, using novel IeDEA tracing study data [ 11 , 12 ], suggests that analyses using only routine programme data may substantially underestimate mortality. The aggregate observed mortality rate in the southern Africa tracing study, which considered CHIV after LTFU, was five times greater than among CHIV recorded as in care by treatment programmes in the same region or globally (9.4 vs. 1.5 or 1.8 deaths per 100 person‐years, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…We also utilized data from a recent IeDEA tracing study in six treatment programmes in five countries (Zambia, Malawi, Zimbabwe, Lesotho and Mozambique) in southern Africa. From the traced sample of 3256 persons classified as LTFU by participating programmes [11,12], we used the subsample of CHIV aged younger than 15 years, who had not visited the clinic for at least the previous 120 to 180 days, depending on local definitions of LTFU. The children's outcomes were determined using phone calls and home visits.…”

Section: E T H O D S 21 Data Sourcesmentioning

confidence: 99%

“…In this study, we estimated all-cause mortality rates and investigated their temporal trends among CHIV younger than 15 years on ART, during 2004 to 2017, in multiple regions within and outside of Africa. Unique to this analysis are the two distinct data sources: for all regions, we used routinecare IeDEA observational data from participating treatment programmes; for southern Africa, we additionally used novel IeDEA data from a recent tracing study that determined outcomes in a sample of CHIV considered LTFU [11,12]. The second data source provided insights into deaths that are potentially missed by programmes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Global HIV mortality trends among children on antiretroviral treatment corrected for under‐reported deaths: an updated analysis of the International epidemiology Databases to Evaluate AIDS collaboration

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction The Joint United Nations Programme on HIV/AIDS (UNAIDS) projections of paediatric HIV prevalence and deaths rely on the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium for mortality estimates among children living with HIV (CHIV) receiving antiretroviral therapy (ART). Previous estimates, based on data through 2014, may no longer be accurate due to expanded paediatric HIV care and treatment eligibility, and the possibility of unreported deaths in CHIV considered lost to follow‐up (LTFU). We therefore estimated all‐cause mortality and its trends in CHIV (<15 years old) on ART using extended and new IeDEA data. Methods We analysed (i) IeDEA observational data from CHIV in routine care globally, and (ii) novel data from an IeDEA tracing study that determined outcomes in a sample of CHIV after being LTFU in southern Africa. We included 45,711 CHIV on ART during 2004 to 2017 at 72 programmes in Africa, Asia‐Pacific and Latin America. We used mixed effects Poisson regression to estimate mortality by age, sex, CD4 at ART start, time on ART, region and calendar year. For Africa, in an adjusted analysis that accounts for unreported deaths among those LTFU, we first modified the routine data by simulating mortality outcomes within six months after LTFU, based on a Gompertz survival model fitted to the tracing data ( n = 221). Results Observed mortality rates were 1.8 (95% CI: 1.7 to 1.9) and 9.4 (6.3 to 13.4) deaths per 100 person‐years in the routine and tracing data, respectively. We found strong evidence of higher mortality at shorter ART durations, lower CD4 values, and in infancy. Averaging over covariate patterns, the adjusted mortality rate was 54% higher than the unadjusted rate. In unadjusted analyses, mortality reduced by an average 60% and 73% from 2005 to 2017, within and outside of Africa, respectively. In the adjusted analysis for Africa, this temporal reduction was 42%. Conclusions Mortality rates among CHIV have decreased substantially over time. However, when accounting for worse outcomes among those LTFU, mortality estimates increased and temporal improvements were slightly reduced, suggesting caution in interpreting analyses based only on programme data. The improved and updated IeDEA estimates on mortality among CHIV on ART support UNAIDS efforts to accurately model global HIV statistics.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: E T H O D S 21 Data Sourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Global HIV mortality trends among children on antiretroviral treatment corrected for under‐reported deaths: an updated analysis of the International epidemiology Databases to Evaluate AIDS collaboration

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The protocol for this cohort study is available on Open Science Framework [17]. PLHIV from six Southern African countries were eligible if classified as lost to follow-up between January 1, 2014, and June 30, 2017, based on ART programs' databases.…”

Section: Methodsmentioning

confidence: 99%

Tracing People Living With Human Immunodeficiency Virus Who Are Lost to Follow-up at Antiretroviral Therapy Programs in Southern Africa: A Sampling-Based Cohort Study in 6 Countries

Ballif

Christ

Anderegg

et al. 2021

Clinical Infectious Diseases

Self Cite

View full text Add to dashboard Cite

Background Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with HIV (PLHIV) lost to follow-up (LTFU) 2014-2017 at ART programs in Southern Africa. Methods We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in eight ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe, 2017-2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting. Results Among 3,256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2,294 PLHIV (71%) by phone calls, home visits or both: 768 (34% of 2,294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1,323 (41% of 3,256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, higher in PLHIV who had been on ART <1 year or lost >1 year, living further from the clinic or in rural areas. Results were heterogeneous across sites. Conclusions Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU.

show abstract

“…Weights consisted of two-stage inverse probability weights to upweight those successfully traced accounting for the sampling strategy and likelihood of being found by the tracer to make results representative of all lost CAYHIV (methods to construct weights are explained elsewhere). 9,12,13 We measured follow-up time from the last clinic visit to (1) death date if informed to have died, or (2) site-specific tracing date if found alive. We assumed all missing immune-suppression data (variable constructed from CD4 count/percent and age) were missing at random (MAR) and multiply-imputed these data with a chained equation approach.…”

Section: Discussionmentioning

confidence: 99%

High Unreported Mortality in Children and Youth (<25 Years) Living With HIV Who Were Lost to Care From Antiretroviral Therapy Programs in Southern Africa: Results From a Multicountry Tracing Study

Nyakato

Christ

Anderegg

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Background: Antiretroviral therapy program mortality maybe underestimated if deceased patients are misclassified as lost. Methods:We used two-stage inverse probability weighting to account for probability of being: sampled for tracing and found by the tracer.Results: Among 680 children and youth aged ,25 years on antiretroviral therapy who were lost and traced in Southern Africa between October 2017 and November 2019, estimated mortality was high at 9.1% (62/680). After adjusting for measured covariates and within-site clustering, mortality remained lower for young adults aged 20-24 years compared with infants aged ,2 years [adjusted hazard ratio: 0.40 (95% confidence interval: 0.31 to 0.51)]. Conclusions:Our study confirms high unreported mortality in children and youth who are lost and the need for tracing to assess vital status among those who are lost to accurately report on program mortality.

show abstract

Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: Study protocol

Cited by 4 publications

References 5 publications

Global HIV mortality trends among children on antiretroviral treatment corrected for under‐reported deaths: an updated analysis of the International epidemiology Databases to Evaluate AIDS collaboration

Global HIV mortality trends among children on antiretroviral treatment corrected for under‐reported deaths: an updated analysis of the International epidemiology Databases to Evaluate AIDS collaboration

Tracing People Living With Human Immunodeficiency Virus Who Are Lost to Follow-up at Antiretroviral Therapy Programs in Southern Africa: A Sampling-Based Cohort Study in 6 Countries

High Unreported Mortality in Children and Youth (<25 Years) Living With HIV Who Were Lost to Care From Antiretroviral Therapy Programs in Southern Africa: Results From a Multicountry Tracing Study

Contact Info

Product

Resources

About