Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America
Year: 2011
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. METHODS AND FINDINGS: At a set "status classification" date, patients were categorized as either "active" or "LTFU" according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173-181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%-7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean=150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean=1.2%, 95% CI: 1.0%-1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean=19.9%, 95% CI: 19.1%-21.7%). CONCLUSIONS: Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide. Please see later in the article for the Editors' Summary.
Source: PLoS Medicine
Institutions: Centre for Infectious Disease Research in Zambia, University of Alabama at Birmingham, Indiana University Indianapolis, RTI International, UNSW Sydney, Kirby Institute, Fundación Huésped, University of Bern, Ministry of Health, Inserm, Université Bordeaux Segalen, Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Chiang Mai University, University of California, San Francisco, University of Cape Town, National Institutes of Health
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $6,460
Funders: Doris Duke Charitable Foundation, amfAR, The Foundation for AIDS Research, Vanderbilt University, Aids Fonds, RTI International, University of Bern, University of New South Wales, Mahidol University, National Yang-Ming University, University of Cape Town, Ministerie van Buitenlandse Zaken, National Institutes of Health, National Cancer Institute, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Vanderbilt University-CIDRZ AIDS International Training and Research Program, G5486238090, International Epi Databases to Evaluate AIDS (IEDEA) in central Africa (Region 9), G8321445851, IeDEA Asia-Pacific Research Collaboration, UCSF-Bay Area Center for AIDS Research, Caribbean, Central, and South America network for HIV Epidemiology (CCASAnet), International Epidemiology Databases to EvaluateAIDS (IeDEA) Renewal 4, International epidemiology Databases to Evaluate AIDS (IeDEA) Southern Africa., UAB Center for AIDS Research (CFAR)
OpenAlex ID: W2066534928