Retention in Care and Connection to Care among HIV-Infected Patients on Antiretroviral Therapy in Africa: Estimation via a Sampling-Based Approach

被引：80

作者：

Geng, Elvin H. ^{[1
,7
]}

Glidden, David V. ^{[2
,7
]}

Bwana, Mwebesa Bosco ^{[3
,7
]}

Musinguzi, Nicolas ^{[3
,7
]}

Emenyonu, Nneka ^{[3
,6
,7
]}

Muyindike, Winnie ^{[3
,7
]}

Christopoulos, Katerina A. ^{[1
]}

Neilands, Torsten B. ^{[4
]}

Yiannoutsos, Constantin T. ^{[5
,7
]}

Deeks, Steven G. ^{[1
]}

Bangsberg, David R. ^{[6
,7
]}

Martin, Jeffrey N. ^{[2
,7
]}

机构：

[1] Univ Calif San Francisco, San Francisco Gen Hosp, Dept Med, Div HIV AIDS, San Francisco, CA 94143 USA

[2] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA

[3] Mbarara Univ Sci & Technol, Dept Med, Mbarara, Uganda

[4] Univ Calif San Francisco, Ctr AIDS Prevent Studies, Dept Med, San Francisco, CA USA

[5] Indiana Univ, Dept Med, Div Biostat, Indianapolis, IN USA

[6] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Boston, MA USA

[7] E Africa Int Epidemiol Databases Evaluate AIDS Ie, Eldoret, Kenya

来源：

PLOS ONE | 2011年 / 6卷 / 07期

基金：

美国国家卫生研究院;

关键词：

PATIENTS LOST; FOLLOW-UP; PROGRAMS; MORTALITY; OUTCOMES;

D O I：

10.1371/journal.pone.0021797

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

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.

引用

页数：7

共 22 条

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