TY - JOUR
T1 - Longitudinal care cascade outcomes among people eligible for antiretroviral therapy who are newly linking to care in Zambia
T2 - A multistate analysis
AU - Mody, Aaloke
AU - Glidden, David V.
AU - Eshun-Wilsonova, Ingrid
AU - Sikombe, Kombatende
AU - Simbeza, Sandra
AU - Mukamba, Njekwa
AU - Somwe, Paul
AU - Beres, Laura K.
AU - Pry, Jake
AU - Bolton-Moore, Carolyn
AU - Padian, Nancy
AU - Holmes, Charles B.
AU - Sikazwe, Izukanji
AU - Geng, Elvin H.
N1 - Funding Information:
This work was supported by the National Institute of Allergy and Infectious Diseases (grants T32 AI060530 and K24 AI134413 to E. H. G.), the Bill and Melinda Gates Foundation (grant OPP1105071), and the University of California San Francisco-Gladstone Institute of Virology and Immunology Center for AIDS Research (CFAR) Implementation Science Working Group, a National Institutes of Health–funded program (grant P30 AI027763).
Publisher Copyright:
© The Author(s) 2020.
PY - 2020/11/15
Y1 - 2020/11/15
N2 - Background. Retention in human immunodeficiency virus (HIV) care is dynamic, with patients frequently transitioning in and out of care. Analytical approaches (eg, survival analyses) commonly used to assess HIV care cascade outcomes fail to capture such transitions and therefore incompletely represent care outcomes over time. Methods. We analyzed antiretroviral therapy (ART)-eligible adults newly linking to care at 64 clinics in Zambia between 1 April 2014 and 31 July 2015. We used electronic medical record data and supplemented these with updated care outcomes ascertained by tracing a multistage random sample of patients lost to follow-up (LTFU, >90 days late for last appointment). We performed multistate analyses, incorporating weights from sampling, to estimate the prevalence of 9 care states over time since linkage with respect to ART initiation, retention in care, transfers, and mortality. Results. In sum, 23 227 patients (58% female; median age 34 years [interquartile range 28–41]) were ART-eligible at enrollment. At 1 year, 75.2% had initiated ART and were in care: 61.8% were continuously retained, 6.1% had reengaged after LTFU, and 7.3% had transferred. Also, 10.1% were LTFU within 7 days of enrollment, and 15.2% were LTFU at 1 year (6.7% prior to ART). One year after LTFU, 51.6% of those LTFU prior to ART remained out of care compared to 30.2% of those LTFU after initiating ART. Overall, 6.9% of patients had died by 1 year with 3.0% dying prior to ART. Conclusion. Multistate analyses provide more complete assessments of longitudinal HIV cascade outcomes and reveal treatment gaps at distinct timepoints in care that will still need to be addressed even with universal treatment.
AB - Background. Retention in human immunodeficiency virus (HIV) care is dynamic, with patients frequently transitioning in and out of care. Analytical approaches (eg, survival analyses) commonly used to assess HIV care cascade outcomes fail to capture such transitions and therefore incompletely represent care outcomes over time. Methods. We analyzed antiretroviral therapy (ART)-eligible adults newly linking to care at 64 clinics in Zambia between 1 April 2014 and 31 July 2015. We used electronic medical record data and supplemented these with updated care outcomes ascertained by tracing a multistage random sample of patients lost to follow-up (LTFU, >90 days late for last appointment). We performed multistate analyses, incorporating weights from sampling, to estimate the prevalence of 9 care states over time since linkage with respect to ART initiation, retention in care, transfers, and mortality. Results. In sum, 23 227 patients (58% female; median age 34 years [interquartile range 28–41]) were ART-eligible at enrollment. At 1 year, 75.2% had initiated ART and were in care: 61.8% were continuously retained, 6.1% had reengaged after LTFU, and 7.3% had transferred. Also, 10.1% were LTFU within 7 days of enrollment, and 15.2% were LTFU at 1 year (6.7% prior to ART). One year after LTFU, 51.6% of those LTFU prior to ART remained out of care compared to 30.2% of those LTFU after initiating ART. Overall, 6.9% of patients had died by 1 year with 3.0% dying prior to ART. Conclusion. Multistate analyses provide more complete assessments of longitudinal HIV cascade outcomes and reveal treatment gaps at distinct timepoints in care that will still need to be addressed even with universal treatment.
KW - HIV care cascade
KW - Mortality
KW - Multistate analysis
KW - Retention in care
KW - Zambia
UR - http://www.scopus.com/inward/record.url?scp=85100203149&partnerID=8YFLogxK
U2 - 10.1093/cid/ciaa268
DO - 10.1093/cid/ciaa268
M3 - Article
C2 - 32173743
AN - SCOPUS:85100203149
SN - 1058-4838
VL - 71
SP - E561-E570
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -