Are They Really Lost? “True” Status and Reasons for Treatment Discontinuation among HIV Infected Patients on Antiretroviral Therapy Considered Lost to Follow Up in Urban Malawi
Hannock Tweya,Caryl Feldacker,Janne Estill,Andreas Jahn,Wingston Ng’ambi,Anne Ben-Smith,Olivia Keiser,Mphatso Bokosi,Matthias Egger,Colin Speight,Joe Gumulira,Sam Phiri +11 more
TLDR
The extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on antiretroviral therapy is described and reasons for ART discontinuation are explained using the authors' active tracing program to further improve ART retention programs and policies.Abstract:
INTRODUCTION
Patients who are lost to follow-up (LTFU) while on antiretroviral therapy (ART) pose challenges to the long-term success of ART programs. We describe the extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on ART and explain reasons for ART discontinuation using our active tracing program to further improve ART retention programs and policies.
METHODS
We identified adult ART patients who missed clinic appointment by more than 3 weeks between January 2006 and December 2010, assuming that such patients would miss their doses of antiretroviral drugs. Patients considered LTFU who consented during ART registration were traced by phone or home visits; true ART status after tracing was documented. Reasons for ART discontinuation were also recorded for those who stopped ART.
RESULTS
Of the 4,560 suspected LTFU cases, 1,384 (30%) could not be traced. Of the 3,176 successfully traced patients, 952 (30%) were dead and 2,224 (70%) were alive, of which 2,183 (99.5%) started ART according to phone-based self-reports or physical verification during in-person interviews. Of those who started ART, 957 (44%) stopped ART and 1,226 (56%) reported still taking ART at the time of interview by sourcing drugs from another clinic, using alternative ART sources or making brief ART interruptions. Among 940 cases with reasons for ART discontinuations, failure to remember (17%), too weak/sick (12%), travel (46%), and lack of transport to the clinic (16%) were frequently cited; reasons differed by gender.
CONCLUSION
The LTFU category comprises sizeable proportions of patients still taking ART that may potentially bias retention estimates and misdirect resources at the clinic and national levels if not properly accounted for. Clinics should consider further decentralization efforts, increasing drug allocations for frequent travels, and improving communication on patient transfers between clinics to increase retention and adherence.read more
Citations
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Journal Article
True Outcomes for Patients on Antiretroviral Therapy Who Are "Lost to Follow-Up" in Malawi/Veritables Issues Du Traitement Antiretroviral Pour Les Patients Consideres Comme « Perdus De Vue » Au Malawi/Evolucion Real De Los Pacientes Sometidos a Terapia Antirretroviral Y Perdidos En El Seguimiento En Malawi
Joseph Kwong-Leung Yu,Solomon Chih-Cheng Chen,Kuo-Yang Wang,Chao-Sung Chang,Simon D Makombe,Erik J Schouten,Anthony D. Harries +6 more
TL;DR: The authors in this paper found that 15% of the patients who were lost to follow-up may have died in the first year of ART, with the average being 12% in programmes with active followup and 19% in those with no active follow up.
Journal ArticleDOI
Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi.
Hannock Tweya,Salem Gugsa,Mina C. Hosseinipour,Colin Speight,Wingston Ng’ambi,Mphatso Bokosi,Janet Chikonda,Annie Chauma,Patricia Khomani,Malocho Phoso,Tiwonge Mtande,Sam Phiri +11 more
TL;DR: To assess factors, outcomes and reasons for loss to follow-up (LTFU) among pregnant and breastfeeding women initiated on a lifelong antiretroviral therapy (ART) for PMTCT in a large antenatal clinic in Malawi, a cohort study is conducted.
Journal ArticleDOI
Self-transfer and mortality amongst adults lost to follow-up in ART programmes in low- and middle-income countries: systematic review and meta-analysis
TL;DR: To ascertain estimates of adult patients, recorded as lost to follow‐up (LTFU) within antiretroviral treatment (ART) programmes, who have self‐transferred care, died or truly stopped ART in low‐ and middle‐income countries, data are analyzed.
Journal ArticleDOI
Outcomes of HIV-positive patients lost to follow-up in African treatment programmes.
Kathrin Zürcher,Anne Mooser,Nanina Anderegg,Olga Tymejczyk,Margaret J. Couvillon,Denis Nash,Matthias Egger,Matthias Egger,IeDEA,Mesh consortia +9 more
TL;DR: Changes in outcomes of patients LTFU over calendar time are examined, associations with other study and programme characteristics are assessed and the relative success of different tracing methods are investigated.
Journal ArticleDOI
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 Rice,Elvin Geng,Matthew P. Fox,Matthew P. Fox,James R Hargreaves,Matthias Egger,Matthias Egger +18 more
TL;DR: Outcomes in patients lost to follow-up at 4 years after last contact, 22% had died, 23% had stopped therapy, 15% were in another clinic, and 32% could not be found.
References
More filters
Journal ArticleDOI
Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries.
Paula Braitstein,Mwg Brinkhof,François Dabis,Mauro Schechter,Andrew Boulle,Paolo G. Miotti,Robin Wood,Christian Laurent,Eduardo Sprinz,Catherine Seyler,David R. Bangsberg,Eric Balestre,Jonathan A C Sterne,Margaret T May,Matthias Egger +14 more
TL;DR: Patients starting HAART in resource-poor settings have increased mortality rates in the first months on therapy, compared with those in developed countries, and timely diagnosis and assessment of treatment eligibility, coupled with free provision of HAART might reduce this excess mortality.
Journal ArticleDOI
Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review
TL;DR: Better patient tracing procedures, better understanding of loss to follow-up, and earlier initiation of ART to reduce mortality are needed if retention in ART programs in sub-Saharan Africa is to be improved.
Journal ArticleDOI
Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis
Martin W. G. Brinkhof,Mar Pujades-Rodriguez,Mar Pujades-Rodriguez,Matthias Egger,Matthias Egger +4 more
TL;DR: A substantial minority of adults lost to follow up cannot be traced, and among those traced 20% to 60% had died, which has implications both for patient care and the monitoring and evaluation of programmes.
Journal ArticleDOI
Understanding Reasons for and Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Programs in Africa Through a Sampling-Based Approach
Elvin Geng,David R. Bangsberg,Nicolas Musinguzi,Nneka Emenyonu,Mwebesa Bwana,Constantin T. Yiannoutsos,David V. Glidden,Steven G. Deeks,Jeffrey N. Martin +8 more
TL;DR: Sociostructural factors are the primary reasons for loss to follow-up among HIV-infected adults initiation of antiretroviral therapy in Uganda and both deaths and transfers to other clinics were common.
Journal ArticleDOI
Retention in Care among HIV-Infected Patients in Resource-Limited Settings: Emerging Insights and New Directions
Elvin Geng,Denis Nash,Andrew Kambugu,Yao Zhang,Paula Braitstein,Katerina A. Christopoulos,Winnie Muyindike,Mwebesa Bwana,Constantin T. Yiannoutsos,Maya L. Petersen,Jeffrey N. Martin +10 more
TL;DR: Research to assess and improve retention in care for HIV-infected patients can be strengthened by incorporating novel methods such as sampling-based approaches and a causal analytic framework.