Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa

Estimation via a Sampling-Based approach

Elvin H. Geng, David V. Glidden, Mwebesa Bosco Bwana, Nicolas Musinguzi, Nneka Emenyonu, Winnie Muyindike, Katerina A. Christopoulos, Torsten B. Neilands, Constantin Yiannoutsos, Steven G. Deeks, David R. Bangsberg, Jeffrey N. Martin

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Introduction: Current estimates of retention among HIV-infected patients on antiretroviral therapy (ART) in Africa consider patients who are lost to follow-up (LTF) as well as those who die shortly after their last clinic visit to be no longer in care and to represent limitations in access to care. Yet many lost patients may have "silently" transferred and deaths shortly after the last clinic visit more likely represent limitations in clinical care rather than access to care after initial linkage. Methods: We evaluated HIV-infected adults initiating ART from 1/1/2004 to 9/30/2007 at a clinic in rural Uganda. A representative sample of lost patients was tracked in the community to obtain updated information about care at other ART sites. Updated outcomes were incorporated with probability weights to obtain "corrected" estimates of retention for the entire clinic population. We used the competing risks approach to estimate "connection to care"-the percentage of patients accessing care over time (including those who died while in care). Results: Among 3,628 patients, 829 became lost, 128 were tracked and in 111, updated information was obtained. Of 111, 79 (71%) were alive and 35/48 (73%) of patients interviewed in person were in care and on ART. Patient retention for the clinic population assuming lost patients were not in care was 82.3%, 68.9%, and 60.1% at 1, 2 and 3 years. Incorporating updated care information from the sample of lost patients increased estimates of patient retention to 85.8% to 90.9%, 78.9% to 86.2% and 75.8% to 84.7% at the same time points. Conclusions: Accounting for "silent transfers" and early deaths increased estimates of patient retention and connection to care substantially. Deaths soon after the last clinic visit (potentially reflecting limitations in clinical effectiveness) and disconnection from care among patient who were alive each accounted for approximately half of failures of retention.

Original languageEnglish
Article numbere21797
JournalPLoS One
Volume6
Issue number7
DOIs
StatePublished - 2011

Fingerprint

HIV
Sampling
therapeutics
sampling
Ambulatory Care
Therapeutics
patient care
death
Patient Care
Uganda
Lost to Follow-Up
Population
Weights and Measures

ASJC Scopus subject areas

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

Cite this

Geng, E. H., Glidden, D. V., Bwana, M. B., Musinguzi, N., Emenyonu, N., Muyindike, W., ... Martin, J. N. (2011). Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa: Estimation via a Sampling-Based approach. PLoS One, 6(7), [e21797]. https://doi.org/10.1371/journal.pone.0021797

Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa : Estimation via a Sampling-Based approach. / Geng, Elvin H.; Glidden, David V.; Bwana, Mwebesa Bosco; Musinguzi, Nicolas; Emenyonu, Nneka; Muyindike, Winnie; Christopoulos, Katerina A.; Neilands, Torsten B.; Yiannoutsos, Constantin; Deeks, Steven G.; Bangsberg, David R.; Martin, Jeffrey N.

In: PLoS One, Vol. 6, No. 7, e21797, 2011.

Research output: Contribution to journalArticle

Geng, EH, Glidden, DV, Bwana, MB, Musinguzi, N, Emenyonu, N, Muyindike, W, Christopoulos, KA, Neilands, TB, Yiannoutsos, C, Deeks, SG, Bangsberg, DR & Martin, JN 2011, 'Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa: Estimation via a Sampling-Based approach', PLoS One, vol. 6, no. 7, e21797. https://doi.org/10.1371/journal.pone.0021797
Geng, Elvin H. ; Glidden, David V. ; Bwana, Mwebesa Bosco ; Musinguzi, Nicolas ; Emenyonu, Nneka ; Muyindike, Winnie ; Christopoulos, Katerina A. ; Neilands, Torsten B. ; Yiannoutsos, Constantin ; Deeks, Steven G. ; Bangsberg, David R. ; Martin, Jeffrey N. / Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa : Estimation via a Sampling-Based approach. In: PLoS One. 2011 ; Vol. 6, No. 7.
@article{ba0ec358e3a94999afe597089936b635,
title = "Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa: Estimation via a Sampling-Based approach",
abstract = "Introduction: Current estimates of retention among HIV-infected patients on antiretroviral therapy (ART) in Africa consider patients who are lost to follow-up (LTF) as well as those who die shortly after their last clinic visit to be no longer in care and to represent limitations in access to care. Yet many lost patients may have {"}silently{"} transferred and deaths shortly after the last clinic visit more likely represent limitations in clinical care rather than access to care after initial linkage. Methods: We evaluated HIV-infected adults initiating ART from 1/1/2004 to 9/30/2007 at a clinic in rural Uganda. A representative sample of lost patients was tracked in the community to obtain updated information about care at other ART sites. Updated outcomes were incorporated with probability weights to obtain {"}corrected{"} estimates of retention for the entire clinic population. We used the competing risks approach to estimate {"}connection to care{"}-the percentage of patients accessing care over time (including those who died while in care). Results: Among 3,628 patients, 829 became lost, 128 were tracked and in 111, updated information was obtained. Of 111, 79 (71{\%}) were alive and 35/48 (73{\%}) of patients interviewed in person were in care and on ART. Patient retention for the clinic population assuming lost patients were not in care was 82.3{\%}, 68.9{\%}, and 60.1{\%} at 1, 2 and 3 years. Incorporating updated care information from the sample of lost patients increased estimates of patient retention to 85.8{\%} to 90.9{\%}, 78.9{\%} to 86.2{\%} and 75.8{\%} to 84.7{\%} at the same time points. Conclusions: Accounting for {"}silent transfers{"} and early deaths increased estimates of patient retention and connection to care substantially. Deaths soon after the last clinic visit (potentially reflecting limitations in clinical effectiveness) and disconnection from care among patient who were alive each accounted for approximately half of failures of retention.",
author = "Geng, {Elvin H.} and Glidden, {David V.} and Bwana, {Mwebesa Bosco} and Nicolas Musinguzi and Nneka Emenyonu and Winnie Muyindike and Christopoulos, {Katerina A.} and Neilands, {Torsten B.} and Constantin Yiannoutsos and Deeks, {Steven G.} and Bangsberg, {David R.} and Martin, {Jeffrey N.}",
year = "2011",
doi = "10.1371/journal.pone.0021797",
language = "English",
volume = "6",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "7",

}

TY - JOUR

T1 - Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa

T2 - Estimation via a Sampling-Based approach

AU - Geng, Elvin H.

AU - Glidden, David V.

AU - Bwana, Mwebesa Bosco

AU - Musinguzi, Nicolas

AU - Emenyonu, Nneka

AU - Muyindike, Winnie

AU - Christopoulos, Katerina A.

AU - Neilands, Torsten B.

AU - Yiannoutsos, Constantin

AU - Deeks, Steven G.

AU - Bangsberg, David R.

AU - Martin, Jeffrey N.

PY - 2011

Y1 - 2011

N2 - Introduction: Current estimates of retention among HIV-infected patients on antiretroviral therapy (ART) in Africa consider patients who are lost to follow-up (LTF) as well as those who die shortly after their last clinic visit to be no longer in care and to represent limitations in access to care. Yet many lost patients may have "silently" transferred and deaths shortly after the last clinic visit more likely represent limitations in clinical care rather than access to care after initial linkage. Methods: We evaluated HIV-infected adults initiating ART from 1/1/2004 to 9/30/2007 at a clinic in rural Uganda. A representative sample of lost patients was tracked in the community to obtain updated information about care at other ART sites. Updated outcomes were incorporated with probability weights to obtain "corrected" estimates of retention for the entire clinic population. We used the competing risks approach to estimate "connection to care"-the percentage of patients accessing care over time (including those who died while in care). Results: Among 3,628 patients, 829 became lost, 128 were tracked and in 111, updated information was obtained. Of 111, 79 (71%) were alive and 35/48 (73%) of patients interviewed in person were in care and on ART. Patient retention for the clinic population assuming lost patients were not in care was 82.3%, 68.9%, and 60.1% at 1, 2 and 3 years. Incorporating updated care information from the sample of lost patients increased estimates of patient retention to 85.8% to 90.9%, 78.9% to 86.2% and 75.8% to 84.7% at the same time points. Conclusions: Accounting for "silent transfers" and early deaths increased estimates of patient retention and connection to care substantially. Deaths soon after the last clinic visit (potentially reflecting limitations in clinical effectiveness) and disconnection from care among patient who were alive each accounted for approximately half of failures of retention.

AB - Introduction: Current estimates of retention among HIV-infected patients on antiretroviral therapy (ART) in Africa consider patients who are lost to follow-up (LTF) as well as those who die shortly after their last clinic visit to be no longer in care and to represent limitations in access to care. Yet many lost patients may have "silently" transferred and deaths shortly after the last clinic visit more likely represent limitations in clinical care rather than access to care after initial linkage. Methods: We evaluated HIV-infected adults initiating ART from 1/1/2004 to 9/30/2007 at a clinic in rural Uganda. A representative sample of lost patients was tracked in the community to obtain updated information about care at other ART sites. Updated outcomes were incorporated with probability weights to obtain "corrected" estimates of retention for the entire clinic population. We used the competing risks approach to estimate "connection to care"-the percentage of patients accessing care over time (including those who died while in care). Results: Among 3,628 patients, 829 became lost, 128 were tracked and in 111, updated information was obtained. Of 111, 79 (71%) were alive and 35/48 (73%) of patients interviewed in person were in care and on ART. Patient retention for the clinic population assuming lost patients were not in care was 82.3%, 68.9%, and 60.1% at 1, 2 and 3 years. Incorporating updated care information from the sample of lost patients increased estimates of patient retention to 85.8% to 90.9%, 78.9% to 86.2% and 75.8% to 84.7% at the same time points. Conclusions: Accounting for "silent transfers" and early deaths increased estimates of patient retention and connection to care substantially. Deaths soon after the last clinic visit (potentially reflecting limitations in clinical effectiveness) and disconnection from care among patient who were alive each accounted for approximately half of failures of retention.

UR - http://www.scopus.com/inward/record.url?scp=79960754251&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960754251&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0021797

DO - 10.1371/journal.pone.0021797

M3 - Article

VL - 6

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 7

M1 - e21797

ER -