en
Scientific article
Open access
English

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

Publication date2018
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.

Citation (ISO format)
CHAMMARTIN, Frédérique et al. Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis. In: Clinical Infectious Diseases, 2018. doi: 10.1093/cid/ciy347
Main files (1)
Article (Published version)
Identifiers
ISSN of the journal1058-4838
393views
126downloads

Technical informations

Creation06/12/2018 8:42:00 PM
First validation06/12/2018 8:42:00 PM
Update time03/15/2023 8:27:06 AM
Status update03/15/2023 8:27:04 AM
Last indexation05/02/2024 8:33:11 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack