Comparison of methods for correction of mortality estimates for loss to follow-up after ART initiation: A case of the infectious diseases institute, Uganda

Agnes N. Kiragga, Barbara Castelnuovo, Rachel Musomba, Jonathan Levin, Andrew Kambugu, Yukari C. Manabe, Constantin Yiannoutsos, Noah Kiwanuka

Research output: Contribution to journalArticle

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Abstract

Background: In sub-Saharan Africa, a large proportion of HIV positive patients on antiretroviral therapy (ART) are lost to follow-up, some of whom are dead. The objective of this study was to validate methods used to correct mortality estimates for loss-to-follow-up using a cohort with complete death ascertainment. Methods: Routinely collected data from HIV patients initiating first line antiretroviral therapy (ART) at the Infectious Diseases Institute (IDI) (Routine Cohort) was used. Three methods to estimate mortality after initiation were: 1) standard Kaplan-Meier estimation (uncorrected method) that uses passively observed data; 2) double-sampling methods by Frangakis and Rubin (F&R) where deaths obtained from patient tracing studies are given a higher weight than those passively ascertained; 3) Nomogram proposed by Egger et al. Corrected mortality estimates in the Routine Cohort, were compared with the estimates from the IDI research observational cohort (Research Cohort), which was used as the "gold-standard". Results: We included 5,633 patients from the Routine Cohort and 559 from the Research Cohort. Uncorrected mortality estimates (95% confidence interval [1]) in the Routine Cohort at 1, 2 and 3 years were 5.5% (4.9%-6.3%), 6.6% (5.9%-7.5%) and 7.4% (6.5%-8.5%), respectively. The F&R corrected estimates at 1, 2 and 3 years were 11.2% (5.8%-21.2%), 15.8% (9.9%-24.8%) and 18.5% (12.3% -27.2%) respectively. The estimates obtained from the Research Cohort were 15.6% (12.8%-18.9%), 17.5% (14.6%-21.0%) and 19.0% (15.3%-21.9%) at 1, 2 and 3 years respectively. Using the nomogram method in the Routine Cohort, the corrected programme-level mortality estimate in year 1 was 11.9% (8.0%-15.7%). Conclusion: Mortality adjustments provided by the F&R and nomogram methods are adequate and should be employed to correct mortality for loss-to-follow-up in large HIV care centres in Sub-Saharan Africa.

Original languageEnglish
Article numbere83524
JournalPLoS One
Volume8
Issue number12
DOIs
StatePublished - Dec 31 2013

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Uganda
Nomograms
infectious diseases
Communicable Diseases
therapeutics
Mortality
Africa South of the Sahara
HIV
Sub-Saharan Africa
Therapeutics
methodology
Gold
Research
death
Sampling
Lost to Follow-Up
gold
confidence interval
Confidence Intervals
Weights and Measures

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Comparison of methods for correction of mortality estimates for loss to follow-up after ART initiation : A case of the infectious diseases institute, Uganda. / Kiragga, Agnes N.; Castelnuovo, Barbara; Musomba, Rachel; Levin, Jonathan; Kambugu, Andrew; Manabe, Yukari C.; Yiannoutsos, Constantin; Kiwanuka, Noah.

In: PLoS One, Vol. 8, No. 12, e83524, 31.12.2013.

Research output: Contribution to journalArticle

Kiragga, Agnes N. ; Castelnuovo, Barbara ; Musomba, Rachel ; Levin, Jonathan ; Kambugu, Andrew ; Manabe, Yukari C. ; Yiannoutsos, Constantin ; Kiwanuka, Noah. / Comparison of methods for correction of mortality estimates for loss to follow-up after ART initiation : A case of the infectious diseases institute, Uganda. In: PLoS One. 2013 ; Vol. 8, No. 12.
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abstract = "Background: In sub-Saharan Africa, a large proportion of HIV positive patients on antiretroviral therapy (ART) are lost to follow-up, some of whom are dead. The objective of this study was to validate methods used to correct mortality estimates for loss-to-follow-up using a cohort with complete death ascertainment. Methods: Routinely collected data from HIV patients initiating first line antiretroviral therapy (ART) at the Infectious Diseases Institute (IDI) (Routine Cohort) was used. Three methods to estimate mortality after initiation were: 1) standard Kaplan-Meier estimation (uncorrected method) that uses passively observed data; 2) double-sampling methods by Frangakis and Rubin (F&R) where deaths obtained from patient tracing studies are given a higher weight than those passively ascertained; 3) Nomogram proposed by Egger et al. Corrected mortality estimates in the Routine Cohort, were compared with the estimates from the IDI research observational cohort (Research Cohort), which was used as the {"}gold-standard{"}. Results: We included 5,633 patients from the Routine Cohort and 559 from the Research Cohort. Uncorrected mortality estimates (95{\%} confidence interval [1]) in the Routine Cohort at 1, 2 and 3 years were 5.5{\%} (4.9{\%}-6.3{\%}), 6.6{\%} (5.9{\%}-7.5{\%}) and 7.4{\%} (6.5{\%}-8.5{\%}), respectively. The F&R corrected estimates at 1, 2 and 3 years were 11.2{\%} (5.8{\%}-21.2{\%}), 15.8{\%} (9.9{\%}-24.8{\%}) and 18.5{\%} (12.3{\%} -27.2{\%}) respectively. The estimates obtained from the Research Cohort were 15.6{\%} (12.8{\%}-18.9{\%}), 17.5{\%} (14.6{\%}-21.0{\%}) and 19.0{\%} (15.3{\%}-21.9{\%}) at 1, 2 and 3 years respectively. Using the nomogram method in the Routine Cohort, the corrected programme-level mortality estimate in year 1 was 11.9{\%} (8.0{\%}-15.7{\%}). Conclusion: Mortality adjustments provided by the F&R and nomogram methods are adequate and should be employed to correct mortality for loss-to-follow-up in large HIV care centres in Sub-Saharan Africa.",
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T2 - A case of the infectious diseases institute, Uganda

AU - Kiragga, Agnes N.

AU - Castelnuovo, Barbara

AU - Musomba, Rachel

AU - Levin, Jonathan

AU - Kambugu, Andrew

AU - Manabe, Yukari C.

AU - Yiannoutsos, Constantin

AU - Kiwanuka, Noah

PY - 2013/12/31

Y1 - 2013/12/31

N2 - Background: In sub-Saharan Africa, a large proportion of HIV positive patients on antiretroviral therapy (ART) are lost to follow-up, some of whom are dead. The objective of this study was to validate methods used to correct mortality estimates for loss-to-follow-up using a cohort with complete death ascertainment. Methods: Routinely collected data from HIV patients initiating first line antiretroviral therapy (ART) at the Infectious Diseases Institute (IDI) (Routine Cohort) was used. Three methods to estimate mortality after initiation were: 1) standard Kaplan-Meier estimation (uncorrected method) that uses passively observed data; 2) double-sampling methods by Frangakis and Rubin (F&R) where deaths obtained from patient tracing studies are given a higher weight than those passively ascertained; 3) Nomogram proposed by Egger et al. Corrected mortality estimates in the Routine Cohort, were compared with the estimates from the IDI research observational cohort (Research Cohort), which was used as the "gold-standard". Results: We included 5,633 patients from the Routine Cohort and 559 from the Research Cohort. Uncorrected mortality estimates (95% confidence interval [1]) in the Routine Cohort at 1, 2 and 3 years were 5.5% (4.9%-6.3%), 6.6% (5.9%-7.5%) and 7.4% (6.5%-8.5%), respectively. The F&R corrected estimates at 1, 2 and 3 years were 11.2% (5.8%-21.2%), 15.8% (9.9%-24.8%) and 18.5% (12.3% -27.2%) respectively. The estimates obtained from the Research Cohort were 15.6% (12.8%-18.9%), 17.5% (14.6%-21.0%) and 19.0% (15.3%-21.9%) at 1, 2 and 3 years respectively. Using the nomogram method in the Routine Cohort, the corrected programme-level mortality estimate in year 1 was 11.9% (8.0%-15.7%). Conclusion: Mortality adjustments provided by the F&R and nomogram methods are adequate and should be employed to correct mortality for loss-to-follow-up in large HIV care centres in Sub-Saharan Africa.

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