Incorporating loss to follow-up in estimates of survival among HIV-infected individuals in sub-saharan Africa enrolled in antiretroviral therapy programs
ABSTRACT Background. Measuring the survival of adult patients in antiretroviral therapy (ART) programs is complicated by short observation periods and patients lost-to-follow-up (LTFU). We synthesized data from sub-Saharan Africa (SSA) treatment cohorts to estimate survival over five years after initiating ART.Methods. We used data on retention, mortality and loss to follow-up, extracted from 34 cohorts, including a total of 102,306 adult patients from 18 SSA countries, augmented by 13 SSA studies tracking death rates among adult patients LTFU. We used a Poisson regression model to estimate survival over time, incorporating predicted mortality among LTFU patients.Results. Across studies median CD4 count at ART initiation was 104 cells/mm(3), 65% of patients were female, and median age was 37 years. 1-year and 5-year survival, adjusted for loss to follow-up, were estimated at 0.87 (95% C.I: 0.72-0.94) and 0.70 (0.36-0.86), respectively. The life-years gained by a patient over five years after starting treatment were estimated at 2.1 (1.6-2.3) in the adjusted model, compared to 1.7 (1.1-2.0) if assuming 100% mortality among LTFU patients, or 2.4 (1.7-2.7) assuming 0% mortality among LTFU patients.Conclusions. Accounting for loss to follow-up produces substantial changes in the estimated life-years gained during the first five years on ART.
- The Journal of Infectious Diseases 10/2012; DOI:10.1093/infdis/jis639 · 5.78 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: We report on the adherence experience of a group of people living with HIV on ART over six years in Uganda. Between 2005 and 2009, we followed up 41 participants who were also part of a clinical trial comparing home and facility based delivery of ART in Jinja, eastern Uganda. We conducted qualitative in-depth interviews at enrolment, 3, 6, 18 and 30 months to capture experiences with adherence over time. In 2011 we returned to these participants to find out how they were fairing with long term adherence. We managed to retrace 24 participants and interviewed them about their experience. We thematically analysed the data and compared findings over time. Initially there were few barriers to adherence and many followed the adherence guidance closely. By year six, relaxation of these rules was noticeable although self-reported adherence continued to be high. Alcohol consumption was more common than before. Some relatives of the participants who had died claimed that some deaths were a result of alcohol. While participants reported that ART had allowed them to reclaim independence and return to work the changes in work and social routines created new challenges for adherence. Side effects like lipodystrophy were not only causing some stigma but for some tested their faith in the drugs. Many participants reported resumption of sexual lives but apart from those who selected same status partners, disclosure to new partners was minimal. Good adherence practice to ART wanes over the long-term, and people who may have disclosed at initiation find it difficult to do so to new partners once they are healthy. Further adherence interventions and support with disclosure over the course of therapy may need to be considered. (Words: 283).PLoS ONE 10/2013; 8(10):e78243. DOI:10.1371/journal.pone.0078243 · 3.53 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Migration and mobility have had a profound influence on the global HIV epidemic. We propose a network-dyadic conceptual model to interpret previous literature and inform the development of future research with respect to study design, measurement methods, and analytic approach. In this model, HIV transmission is driven by risk behaviors of migrants that emerges and is enabled by mobility, the bridging of sub-epidemics across space and time, and the displacement effects on the primary residential sending community for migrants. To investigate these causal pathways, empirical study designs must measure the relative timing of migratory events, sexual risk behaviors, and incident HIV infections. Network-based mathematical models using empirical data on partnerships help gain insight into the dynamic disease transmission systems. Although the network-dyadic conceptual model and related network methods may not address all questions related to migration and HIV, they provide a unified approach for future research on this important topic.AIDS and Behavior 11/2013; 18(12). DOI:10.1007/s10461-013-0665-z · 3.49 Impact Factor