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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa: Estimation via a Sampling-Based approach
PLoS ONE, Volume 6, No. 7, Article e21797, Year 2011
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Description
Introduction: Current estimates of retention among HIV-infected patients on antiretroviral therapy (ART) in Africa consider patients who are lost to follow-up (LTF) as well as those who die shortly after their last clinic visit to be no longer in care and to represent limitations in access to care. Yet many lost patients may have "silently" transferred and deaths shortly after the last clinic visit more likely represent limitations in clinical care rather than access to care after initial linkage. Methods: We evaluated HIV-infected adults initiating ART from 1/1/2004 to 9/30/2007 at a clinic in rural Uganda. A representative sample of lost patients was tracked in the community to obtain updated information about care at other ART sites. Updated outcomes were incorporated with probability weights to obtain "corrected" estimates of retention for the entire clinic population. We used the competing risks approach to estimate "connection to care"-the percentage of patients accessing care over time (including those who died while in care). Results: Among 3,628 patients, 829 became lost, 128 were tracked and in 111, updated information was obtained. Of 111, 79 (71%) were alive and 35/48 (73%) of patients interviewed in person were in care and on ART. Patient retention for the clinic population assuming lost patients were not in care was 82.3%, 68.9%, and 60.1% at 1, 2 and 3 years. Incorporating updated care information from the sample of lost patients increased estimates of patient retention to 85.8% to 90.9%, 78.9% to 86.2% and 75.8% to 84.7% at the same time points. Conclusions: Accounting for "silent transfers" and early deaths increased estimates of patient retention and connection to care substantially. Deaths soon after the last clinic visit (potentially reflecting limitations in clinical effectiveness) and disconnection from care among patient who were alive each accounted for approximately half of failures of retention. © 2011 Geng et al.
Authors & Co-Authors
Geng, Elvin H.
United States, San Francisco
Ucsf School of Medicine
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Glidden, David V.
United States, San Francisco
University of California, San Francisco
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Bwana, Mwebesa Bosco
Uganda, Mbarara
Mbarara University of Science and Technology
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Musinguzi, Nicholas
Uganda, Mbarara
Mbarara University of Science and Technology
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Emenyonu, Nneka I.
Uganda, Mbarara
Mbarara University of Science and Technology
United States, Boston
Harvard Medical School
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Muyindike, Winnie R.
Uganda, Mbarara
Mbarara University of Science and Technology
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Christopoulos, Katerina
United States, San Francisco
Ucsf School of Medicine
Neilands, Torsten B.
United States, San Francisco
Ucsf School of Medicine
Yiannoutsos, Constantin Theodore
United States, Indianapolis
Indiana University-purdue University Indianapolis
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Deeks, Steven G.
United States, San Francisco
Ucsf School of Medicine
Bangsberg, David R.
United States, Boston
Harvard Medical School
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Martin, Jeffrey N.
United States, San Francisco
University of California, San Francisco
Kenya
East Africa International Epidemiologic Databases to Evaluate Aids Iedea Consortium
Statistics
Citations: 90
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0021797
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Uganda