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Sampling-Based Approach to Determining Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Scale-Up Programs in Africa
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To the Editor: Evaluating outcomes among the millions of HIV-infected patients starting antiretroviral therapy (ART) in settings with limited resources is key to understanding the effect of current treatment programs and guiding future strategies. Accurately assessing survival outcomes has been precluded by substantial numbers of patients not returning for care. One year after starting ART, 15% to 30% of patients are lost to follow-up.1-2 Only by determining the outcomes of those lost can true survival and program impact be understood. We present a sampling-based strategy to address this.
Methods
We evaluated all HIV-infected adults initiating ART in a rural clinic in Mbarara, Uganda, between January 1, 2004, and September 30, 2007. Each month, a tracker sought an unselected and consecutive sample of patients in the community who were lost to follow-up (a 6-month absence from clinic) to obtain their vital status. Naive and corrected estimates of cumulative incidence of mortality were . . . [Full Text of this Article]
Elvin H. Geng, MD, MPH
genge@php.ucsf.edu
Positive Health Program of the Department of Medicine
San Francisco General Hospital
San Francisco, California
Nneka Emenyonu, MPH
Epidemiology Prevention and Intervention Center Department of Medicine
University of California, San Francisco
Mwebesa Bosco Bwana, MBChB, MMed
Mbarara University of Science and Technology
Mbarara, Uganda
David V. Glidden, PhD;
Jeffrey N. Martin, MD, MPH
Department of Epidemiology and Biostatistics
University of California, San Francisco
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