Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis

Frédérique Chammartin, Kathrin Zürcher, Olivia Keiser, Ralf Weigel, Kathryn Chu, Agnes N. Kiragga, Cristina Ardura-Garcia, Nanina Anderegg, Christian Laurent, Morna Cornell, Hannock Tweya, Andreas D. Haas, Brian D. Rice, Elvin H. Geng, Matthew P. Fox, James R. Hargreaves, Matthias Egger

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

Background Low retention on combination antiretroviral therapy (cART) has emerged as a threat to the Joint United Nations Programme on human immunodeficiency virus (HIV)/AIDS (UNAIDS) 90-90-90 targets. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African treatment programs. Methods This was a systematic review and individual patient data meta-analysis of studies that traced patients who were LTFU. Outcomes were analyzed using cumulative incidence functions and proportional hazards models for the competing risks of (i) death, (ii) alive but stopped cART, (iii) silent transfer to other clinics, and (iv) retention on cART. Results Nine studies contributed data on 7377 patients who started cART and were subsequently LTFU in sub-Saharan Africa. The median CD4 count at the start of cART was 129 cells/μL. At 4 years after the last clinic visit, 21.8% (95% confidence interval [CI], 20.8%-22.7%) were known to have died, 22.6% (95% CI, 21.6%-23.6%) were alive but had stopped cART, 14.8% (95% CI, 14.0%-15.6%) had transferred to another clinic, 9.2% (95% CI, 8.5%-9.8%) were retained on cART, and 31.6% (95% CI, 30.6%-32.7%) could not been found. Mortality was associated with male sex, more advanced disease, and shorter cART duration; stopping cART with less advanced disease andlonger cART duration; and silent transfer with female sex and less advanced disease. Conclusions Mortality in patients LTFU must be considered for unbiased assessments of program outcomes and UNAIDS targets in sub-Saharan Africa. Immediate start of cART and early tracing of patients LTFU should be priorities.

Original languageEnglish
Pages (from-to)1643-1652
Number of pages10
JournalClinical Infectious Diseases
Volume67
Issue number11
DOIs
StatePublished - Nov 13 2018

Keywords

  • HIV
  • antiretroviral therapy
  • loss to follow-up
  • mortality
  • sub-Saharan Africa

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