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Home >> Publications >> Do increasing rates of loss to follow-up in antiretroviral treatment programs imply deteriorating patient retention?

Publication

Author(s):

Johnson LF, Estill J, Keiser O, Cornell M, Moolla H, Schomaker M, Grimsrud A, Davies MA, Boulle A.

Pub Title:

Do increasing rates of loss to follow-up in antiretroviral treatment programs imply deteriorating patient retention?

Pub Date:

Dec 15 2014

Pub Region(s):

Southern Africa

Journal Issue:

Epub

Page Number:
1208-12

Journal:

Title: 
American Journal of Epidemiology
Link: 
http://aje.oxfordjournals.org/content/180/12/1208.long

PubMed: 25399412
Pub PDF: PDF icon 25399412.pdf

Abstract
In several studies of antiretroviral treatment (ART) programs for persons with human immunodeficiency virus infection, investigators have reported that there has been a higher rate of loss to follow-up (LTFU) among patients initiating ART in recent years than among patients who initiated ART during earlier time periods. This finding is frequently interpreted as reflecting deterioration of patient retention in the face of increasing patient loads. However, in this paper we demonstrate by simulation that transient gaps in follow-up could lead to bias when standard survival analysis techniques are applied. We created a simulated cohort of patients with different dates of ART initiation. Rates of ART interruption, ART resumption, and mortality were assumed to remain constant over time, but when we applied a standard definition of LTFU, the simulated probability of being classified LTFU at a particular ART duration was substantially higher in recently enrolled cohorts. This suggests that much of the apparent trend towards increased LTFU may be attributed to bias caused by transient interruptions in care. Alternative statistical techniques need to be used when analyzing predictors of LTFU--for example, using "prospective" definitions of LTFU in place of "retrospective" definitions. Similar considerations may apply when analyzing predictors of LTFU from treatment programs for other chronic diseases.

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Citation:

Johnson LF, Estill J, Keiser O, Cornell M, Moolla H, Schomaker M, Grimsrud A, Davies MA, Boulle A. Do increasing rates of loss to follow-up in antiretroviral treatment programs imply deteriorating patient retention? Am J Epidemiol. 2014 Dec 15;180(12):1208-12. doi: 10.1093/aje/kwu295. Epub 2014 Nov 15. PubMed PMID: 25399412; PubMed Central PMCID: PMC4262442.