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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Correcting mortality for loss to follow-up: A nomogram applied to antiretroviral treatment programmes in sub-Saharan Africa
PLoS Medicine, Volume 8, No. 1, Article e1000390, Year 2011
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Description
Background: The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. Methods and Findings: We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in a treatment programme is a weighted average of mortality among patients lost to follow-up and patients remaining in care. The nomogram gives a correction factor based on the percentage of patients lost to follow-up at a given point in time, and the estimated ratio of mortality between patients lost and not lost to follow-up. The mortality observed among patients retained in care is then multiplied by the correction factor to obtain an estimate of programme-level mortality that takes all deaths into account. A web calculator directly calculates the corrected, programme-level mortality with 95% confidence intervals (CIs). We applied the method to 11 ART programmes in sub-Saharan Africa. Patients retained in care had a mortality at 1 year of 1.4% to 12.0%; loss to follow-up ranged from 2.8% to 28.7%; and the correction factor from 1.2 to 8.0. The absolute difference between uncorrected and corrected mortality at 1 year ranged from 1.6% to 9.8%, and was above 5% in four programmes. The largest difference in mortality was in a programme with 28.7% of patients lost to follow-up at 1 year. Conclusions: The amount of bias in mortality estimates can be large in ART programmes with substantial loss to follow-up. Programmes should routinely report mortality among patients retained in care and the proportion of patients lost. A simple nomogram can then be used to estimate mortality among all patients who started ART, for a range of plausible mortality rates among patients lost to follow-up. © 2011 Egger et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3022522/bin/pmed.1000390.s001.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC3022522/bin/pmed.1000390.s002.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC3022522/bin/pmed.1000390.s003.doc
Authors & Co-Authors
Egger, Matthias
Switzerland, Bern
University of Bern
Daniel Spycher, Ben Daniel
Switzerland, Bern
University of Bern
Sidle, John E.
Kenya, Eldoret
Moi University
Weigel, Ralf
Malawi, Lilongwe
Kamuzu Central Hospital
Geng, Elvin H.
United States, San Francisco
Ucsf School of Medicine
Fox, Matthew P.
United States, Boston
School of Public Health
MacPhail, Andrew Patrick
South Africa, Johannesburg
Helen Joseph Hospital
Van Cutsem, Gilles
South Africa, Cape Town
University of Cape Town
Messou, Eugéne
Cote D'ivoire, Abidjan
Centre de Prise en Charge de Recherche et de Formation
Wood, Robin Y.
South Africa, Cape Town
Desmond Tutu Health Foundation
Nash, Denis B.
United States, New York
Mailman School of Public Health
Pascoe, Margaret J.
Zimbabwe, Harare
Newlands Clinic
Dickinson, Diana B.
Unknown Affiliation
Étard, Jean François
France, Montpellier
Ird Centre de Montpellier
McIntyre, James Alasdair
Switzerland, Bern
University of Bern
Brinkhof, Martin W.G.
Switzerland, Bern
University of Bern
Statistics
Citations: 150
Authors: 16
Affiliations: 12
Identifiers
Doi:
10.1371/journal.pmed.1000390
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Infectious Diseases
Study Design
Cohort Study