The causal effect of tracing by peer health workers on return to clinic among patients who were lost to follow-up from antiretroviral therapy in Eastern Africa: A “natural experiment” arising from surveillance of lost patients

East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background. The effect of tracing human immunodeficiency virus (HIV)–infected patients who are lost to follow-up (LTFU) on reengagement has not been rigorously assessed. We carried out an ex post analysis of a surveillance study in which LTFU patients were randomly selected for tracing to identify the effect of tracing on reengagement. Methods. We evaluated HIV-infected adults on antiretroviral therapy who were LTFU (>90 days late for last visit) at 14 clinics in Uganda, Kenya, and Tanzania. A random sample of LTFU patients was selected for tracing by peer health workers. We assessed the effect of selection for tracing using Kaplan-Meier estimates of reengagement among all patients as well as the subset of LTFU patients who were alive, contacted in person by the tracer, and out of care. Results. Of 5781 eligible patients, 991 (17%) were randomly selected for tracing. One year after selection for tracing, 13.3% (95% confidence interval [CI], 11.1%–15.3%) of those selected for tracing returned compared with 10.0% (95% CI, 9.1%–10.8%) of those not randomly selected, an adjusted risk difference of 3.0% (95% CI, .7%–5.3%). Among patients found to be alive, personally contacted, and out of care, tracing increased the absolute probability of return at 1 year by 22% (95% CI, 7.1%–36.2%). The effect of tracing on rate of return to clinic decayed with a half-life of 7.0 days after tracing (95% CI, 2.6 %–12.9%). Conclusions. Tracing interventions increase reengagement, but developing methods for targeting LTFU patients most likely to benefit can make this practice more efficient.

Original languageEnglish (US)
Pages (from-to)1547-1554
Number of pages8
JournalClinical Infectious Diseases
Volume64
Issue number11
DOIs
StatePublished - 2017

Fingerprint

Eastern Africa
Lost to Follow-Up
Health
Confidence Intervals
Therapeutics
HIV
Uganda
Tanzania
Kenya
Kaplan-Meier Estimate
Half-Life

Keywords

  • Africa
  • Antiretroviral therapy
  • Loss to follow-up
  • Retention

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

The causal effect of tracing by peer health workers on return to clinic among patients who were lost to follow-up from antiretroviral therapy in Eastern Africa : A “natural experiment” arising from surveillance of lost patients. / East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium.

In: Clinical Infectious Diseases, Vol. 64, No. 11, 2017, p. 1547-1554.

Research output: Contribution to journalArticle

@article{d13b4ce3fb4444b09b85e2e70baceb92,
title = "The causal effect of tracing by peer health workers on return to clinic among patients who were lost to follow-up from antiretroviral therapy in Eastern Africa: A “natural experiment” arising from surveillance of lost patients",
abstract = "Background. The effect of tracing human immunodeficiency virus (HIV)–infected patients who are lost to follow-up (LTFU) on reengagement has not been rigorously assessed. We carried out an ex post analysis of a surveillance study in which LTFU patients were randomly selected for tracing to identify the effect of tracing on reengagement. Methods. We evaluated HIV-infected adults on antiretroviral therapy who were LTFU (>90 days late for last visit) at 14 clinics in Uganda, Kenya, and Tanzania. A random sample of LTFU patients was selected for tracing by peer health workers. We assessed the effect of selection for tracing using Kaplan-Meier estimates of reengagement among all patients as well as the subset of LTFU patients who were alive, contacted in person by the tracer, and out of care. Results. Of 5781 eligible patients, 991 (17{\%}) were randomly selected for tracing. One year after selection for tracing, 13.3{\%} (95{\%} confidence interval [CI], 11.1{\%}–15.3{\%}) of those selected for tracing returned compared with 10.0{\%} (95{\%} CI, 9.1{\%}–10.8{\%}) of those not randomly selected, an adjusted risk difference of 3.0{\%} (95{\%} CI, .7{\%}–5.3{\%}). Among patients found to be alive, personally contacted, and out of care, tracing increased the absolute probability of return at 1 year by 22{\%} (95{\%} CI, 7.1{\%}–36.2{\%}). The effect of tracing on rate of return to clinic decayed with a half-life of 7.0 days after tracing (95{\%} CI, 2.6 {\%}–12.9{\%}). Conclusions. Tracing interventions increase reengagement, but developing methods for targeting LTFU patients most likely to benefit can make this practice more efficient.",
keywords = "Africa, Antiretroviral therapy, Loss to follow-up, Retention",
author = "{East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium} and Anna Bershetyn and Odeny, {Thomas A.} and Rita Lyamuya and Alice Nakiwogga-Muwanga and Lameck Diero and Mwebesa Bwana and Paula Braitstein and Geoffrey Somi and Andrew Kambugu and Elizabeth Bukusi and Wendy Hartogensis and Glidden, {David V.} and Kara Wools-Kaloustian and Constantin Yiannoutsos and Jeffrey Martin and Geng, {Elvin H.}",
year = "2017",
doi = "10.1093/cid/cix191",
language = "English (US)",
volume = "64",
pages = "1547--1554",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
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T1 - The causal effect of tracing by peer health workers on return to clinic among patients who were lost to follow-up from antiretroviral therapy in Eastern Africa

T2 - A “natural experiment” arising from surveillance of lost patients

AU - East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium

AU - Bershetyn, Anna

AU - Odeny, Thomas A.

AU - Lyamuya, Rita

AU - Nakiwogga-Muwanga, Alice

AU - Diero, Lameck

AU - Bwana, Mwebesa

AU - Braitstein, Paula

AU - Somi, Geoffrey

AU - Kambugu, Andrew

AU - Bukusi, Elizabeth

AU - Hartogensis, Wendy

AU - Glidden, David V.

AU - Wools-Kaloustian, Kara

AU - Yiannoutsos, Constantin

AU - Martin, Jeffrey

AU - Geng, Elvin H.

PY - 2017

Y1 - 2017

N2 - Background. The effect of tracing human immunodeficiency virus (HIV)–infected patients who are lost to follow-up (LTFU) on reengagement has not been rigorously assessed. We carried out an ex post analysis of a surveillance study in which LTFU patients were randomly selected for tracing to identify the effect of tracing on reengagement. Methods. We evaluated HIV-infected adults on antiretroviral therapy who were LTFU (>90 days late for last visit) at 14 clinics in Uganda, Kenya, and Tanzania. A random sample of LTFU patients was selected for tracing by peer health workers. We assessed the effect of selection for tracing using Kaplan-Meier estimates of reengagement among all patients as well as the subset of LTFU patients who were alive, contacted in person by the tracer, and out of care. Results. Of 5781 eligible patients, 991 (17%) were randomly selected for tracing. One year after selection for tracing, 13.3% (95% confidence interval [CI], 11.1%–15.3%) of those selected for tracing returned compared with 10.0% (95% CI, 9.1%–10.8%) of those not randomly selected, an adjusted risk difference of 3.0% (95% CI, .7%–5.3%). Among patients found to be alive, personally contacted, and out of care, tracing increased the absolute probability of return at 1 year by 22% (95% CI, 7.1%–36.2%). The effect of tracing on rate of return to clinic decayed with a half-life of 7.0 days after tracing (95% CI, 2.6 %–12.9%). Conclusions. Tracing interventions increase reengagement, but developing methods for targeting LTFU patients most likely to benefit can make this practice more efficient.

AB - Background. The effect of tracing human immunodeficiency virus (HIV)–infected patients who are lost to follow-up (LTFU) on reengagement has not been rigorously assessed. We carried out an ex post analysis of a surveillance study in which LTFU patients were randomly selected for tracing to identify the effect of tracing on reengagement. Methods. We evaluated HIV-infected adults on antiretroviral therapy who were LTFU (>90 days late for last visit) at 14 clinics in Uganda, Kenya, and Tanzania. A random sample of LTFU patients was selected for tracing by peer health workers. We assessed the effect of selection for tracing using Kaplan-Meier estimates of reengagement among all patients as well as the subset of LTFU patients who were alive, contacted in person by the tracer, and out of care. Results. Of 5781 eligible patients, 991 (17%) were randomly selected for tracing. One year after selection for tracing, 13.3% (95% confidence interval [CI], 11.1%–15.3%) of those selected for tracing returned compared with 10.0% (95% CI, 9.1%–10.8%) of those not randomly selected, an adjusted risk difference of 3.0% (95% CI, .7%–5.3%). Among patients found to be alive, personally contacted, and out of care, tracing increased the absolute probability of return at 1 year by 22% (95% CI, 7.1%–36.2%). The effect of tracing on rate of return to clinic decayed with a half-life of 7.0 days after tracing (95% CI, 2.6 %–12.9%). Conclusions. Tracing interventions increase reengagement, but developing methods for targeting LTFU patients most likely to benefit can make this practice more efficient.

KW - Africa

KW - Antiretroviral therapy

KW - Loss to follow-up

KW - Retention

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U2 - 10.1093/cid/cix191

DO - 10.1093/cid/cix191

M3 - Article

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AN - SCOPUS:85027301826

VL - 64

SP - 1547

EP - 1554

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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