An Empirical Approach to Defining Loss to Follow-up Among Patients Enrolled in Antiretroviral Treatment Programs
In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to de...
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| Veröffentlicht in: | American journal of epidemiology 2010-04, Vol.171 (8), p.924-931 |
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| creator | Chi, Benjamin H. Cantrell, Ronald A. Mwango, Albert Westfall, Andrew O. Mutale, Wilbroad Limbada, Mohammed Mulenga, Lloyd B. Vermund, Sten H. Stringer, Jeffrey S. A. |
| description | In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to determine an empirical “days-late” definition of LTFU among patients on ART. Cohort members were classified as either “in care” or LTFU as of December 31, 2007, according to a range of days-late intervals. The authors then looked forward in the database to determine which patients actually returned to care at any point over the following year. The interval that best minimized LTFU misclassification was described as “best-performing.” Overall, 33,704 HIV-infected adults on ART were included. Nearly one-third (n = 10,196) were at least 1 day late for an appointment. The best-performing LTFU definition was 56 days after a missed visit, which had a sensitivity of 84.1% (95% confidence interval (CI): 83.2, 85.0), specificity of 97.5% (95% CI: 97.3, 97.7), and misclassification of 5.1% (95% CI: 4.8, 5.3). The 60-day threshold performed similarly well, with only a marginal difference ( |
| doi_str_mv | 10.1093/aje/kwq008 |
| format | Article |
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A.</creator><creatorcontrib>Chi, Benjamin H. ; Cantrell, Ronald A. ; Mwango, Albert ; Westfall, Andrew O. ; Mutale, Wilbroad ; Limbada, Mohammed ; Mulenga, Lloyd B. ; Vermund, Sten H. ; Stringer, Jeffrey S. A.</creatorcontrib><description>In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to determine an empirical “days-late” definition of LTFU among patients on ART. Cohort members were classified as either “in care” or LTFU as of December 31, 2007, according to a range of days-late intervals. The authors then looked forward in the database to determine which patients actually returned to care at any point over the following year. The interval that best minimized LTFU misclassification was described as “best-performing.” Overall, 33,704 HIV-infected adults on ART were included. Nearly one-third (n = 10,196) were at least 1 day late for an appointment. The best-performing LTFU definition was 56 days after a missed visit, which had a sensitivity of 84.1% (95% confidence interval (CI): 83.2, 85.0), specificity of 97.5% (95% CI: 97.3, 97.7), and misclassification of 5.1% (95% CI: 4.8, 5.3). The 60-day threshold performed similarly well, with only a marginal difference (<0.1%) in misclassification. This analysis suggests that ≥60 days since the last appointment is a reasonable definition of LTFU. Standardization to empirically derived definitions of LTFU will permit more reliable comparisons within and across programs.</description><identifier>ISSN: 0002-9262</identifier><identifier>EISSN: 1476-6256</identifier><identifier>DOI: 10.1093/aje/kwq008</identifier><identifier>PMID: 20219765</identifier><identifier>CODEN: AJEPAS</identifier><language>eng</language><publisher>Cary, NC: Oxford University Press</publisher><subject>Adult ; Africa ; Anti-HIV Agents - therapeutic use ; Antiretroviral drugs ; antiretroviral therapy ; Appointments and Schedules ; Biological and medical sciences ; Cohort Studies ; Confidence intervals ; Data Interpretation, Statistical ; Drug Monitoring - statistics & numerical data ; Drug therapy ; Epidemiology ; follow-up studies ; highly active ; HIV ; HIV Infections - drug therapy ; HIV Infections - mortality ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious diseases ; Medical Records Systems, Computerized ; Medical sciences ; Medication Adherence - statistics & numerical data ; patient dropouts ; Patient Dropouts - classification ; Patient Dropouts - statistics & numerical data ; Practice of Epidemiology ; ROC Curve ; Sensitivity and Specificity ; Time Factors ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Zambia ; Zambia - epidemiology</subject><ispartof>American journal of epidemiology, 2010-04, Vol.171 (8), p.924-931</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright Oxford Publishing Limited(England) Apr 15, 2010</rights><rights>American Journal of Epidemiology © The Author 2010. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c504t-31ead03f4ad96641cc8aafa84a20b553fbbbecbed918b575523417b2a29e5d543</citedby><cites>FETCH-LOGICAL-c504t-31ead03f4ad96641cc8aafa84a20b553fbbbecbed918b575523417b2a29e5d543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22745035$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20219765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chi, Benjamin H.</creatorcontrib><creatorcontrib>Cantrell, Ronald A.</creatorcontrib><creatorcontrib>Mwango, Albert</creatorcontrib><creatorcontrib>Westfall, Andrew O.</creatorcontrib><creatorcontrib>Mutale, Wilbroad</creatorcontrib><creatorcontrib>Limbada, Mohammed</creatorcontrib><creatorcontrib>Mulenga, Lloyd B.</creatorcontrib><creatorcontrib>Vermund, Sten H.</creatorcontrib><creatorcontrib>Stringer, Jeffrey S. A.</creatorcontrib><title>An Empirical Approach to Defining Loss to Follow-up Among Patients Enrolled in Antiretroviral Treatment Programs</title><title>American journal of epidemiology</title><addtitle>Am J Epidemiol</addtitle><description>In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to determine an empirical “days-late” definition of LTFU among patients on ART. Cohort members were classified as either “in care” or LTFU as of December 31, 2007, according to a range of days-late intervals. The authors then looked forward in the database to determine which patients actually returned to care at any point over the following year. The interval that best minimized LTFU misclassification was described as “best-performing.” Overall, 33,704 HIV-infected adults on ART were included. Nearly one-third (n = 10,196) were at least 1 day late for an appointment. The best-performing LTFU definition was 56 days after a missed visit, which had a sensitivity of 84.1% (95% confidence interval (CI): 83.2, 85.0), specificity of 97.5% (95% CI: 97.3, 97.7), and misclassification of 5.1% (95% CI: 4.8, 5.3). The 60-day threshold performed similarly well, with only a marginal difference (<0.1%) in misclassification. This analysis suggests that ≥60 days since the last appointment is a reasonable definition of LTFU. Standardization to empirically derived definitions of LTFU will permit more reliable comparisons within and across programs.</description><subject>Adult</subject><subject>Africa</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral drugs</subject><subject>antiretroviral therapy</subject><subject>Appointments and Schedules</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Data Interpretation, Statistical</subject><subject>Drug Monitoring - statistics & numerical data</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>follow-up studies</subject><subject>highly active</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - mortality</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infectious diseases</subject><subject>Medical Records Systems, Computerized</subject><subject>Medical sciences</subject><subject>Medication Adherence - statistics & numerical data</subject><subject>patient dropouts</subject><subject>Patient Dropouts - classification</subject><subject>Patient Dropouts - statistics & numerical data</subject><subject>Practice of Epidemiology</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Time Factors</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Zambia</subject><subject>Zambia - epidemiology</subject><issn>0002-9262</issn><issn>1476-6256</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkd1r1EAUxQdR7Lb64h8ggyBCIXa-k7wIoW6tuMWCVcSXYTKZbGebzKQzSav_vRN2XT9efLpw74_DOfcA8Ayj1xiV9ERtzMnN_S1CxQOwwCwXmSBcPAQLhBDJSiLIATiMcYMQxiVHj8EBQQSXueALMFQOLvvBBqtVB6thCF7pazh6-Na01lm3hisf47w4813n77NpgFXv0_5Sjda4McKlC-lkGmgdrNxogxmDv7MhCV4Fo8Y-UfAy-HVQfXwCHrWqi-bpbh6Bz2fLq9PzbPXx3fvTapVpjtiYUWxUg2jLVFMKwbDWhVKtKpgiqOactnVdG12bpsRFzXPOCWU4r4kipeENZ_QIvNnqDlPdm0YnD8mQHILtVfghvbLy74uz13Lt7yQpOCpzkgRe7QSCv51MHGVvozZdp5zxU5Q544LRnIv_k5QWIhds1nzxD7nxU3DpD5JQXlIh-AwdbyEd0ueDafemMZJz4TIVLreFJ_j5nzH36K-GE_ByB6iYKm6DctrG3xxJORCduWzL2Tia7_u7CjdS5CmmPP_6TX65-HDxifAiuf0Ju4DFRg</recordid><startdate>20100415</startdate><enddate>20100415</enddate><creator>Chi, Benjamin H.</creator><creator>Cantrell, Ronald A.</creator><creator>Mwango, Albert</creator><creator>Westfall, Andrew O.</creator><creator>Mutale, Wilbroad</creator><creator>Limbada, Mohammed</creator><creator>Mulenga, Lloyd B.</creator><creator>Vermund, Sten H.</creator><creator>Stringer, Jeffrey S. A.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T2</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20100415</creationdate><title>An Empirical Approach to Defining Loss to Follow-up Among Patients Enrolled in Antiretroviral Treatment Programs</title><author>Chi, Benjamin H. ; Cantrell, Ronald A. ; Mwango, Albert ; Westfall, Andrew O. ; Mutale, Wilbroad ; Limbada, Mohammed ; Mulenga, Lloyd B. ; Vermund, Sten H. ; Stringer, Jeffrey S. 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A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An Empirical Approach to Defining Loss to Follow-up Among Patients Enrolled in Antiretroviral Treatment Programs</atitle><jtitle>American journal of epidemiology</jtitle><addtitle>Am J Epidemiol</addtitle><date>2010-04-15</date><risdate>2010</risdate><volume>171</volume><issue>8</issue><spage>924</spage><epage>931</epage><pages>924-931</pages><issn>0002-9262</issn><eissn>1476-6256</eissn><coden>AJEPAS</coden><abstract>In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to determine an empirical “days-late” definition of LTFU among patients on ART. Cohort members were classified as either “in care” or LTFU as of December 31, 2007, according to a range of days-late intervals. The authors then looked forward in the database to determine which patients actually returned to care at any point over the following year. The interval that best minimized LTFU misclassification was described as “best-performing.” Overall, 33,704 HIV-infected adults on ART were included. Nearly one-third (n = 10,196) were at least 1 day late for an appointment. The best-performing LTFU definition was 56 days after a missed visit, which had a sensitivity of 84.1% (95% confidence interval (CI): 83.2, 85.0), specificity of 97.5% (95% CI: 97.3, 97.7), and misclassification of 5.1% (95% CI: 4.8, 5.3). The 60-day threshold performed similarly well, with only a marginal difference (<0.1%) in misclassification. This analysis suggests that ≥60 days since the last appointment is a reasonable definition of LTFU. Standardization to empirically derived definitions of LTFU will permit more reliable comparisons within and across programs.</abstract><cop>Cary, NC</cop><pub>Oxford University Press</pub><pmid>20219765</pmid><doi>10.1093/aje/kwq008</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | American journal of epidemiology, 2010-04, Vol.171 (8), p.924-931 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Africa Anti-HIV Agents - therapeutic use Antiretroviral drugs antiretroviral therapy Appointments and Schedules Biological and medical sciences Cohort Studies Confidence intervals Data Interpretation, Statistical Drug Monitoring - statistics & numerical data Drug therapy Epidemiology follow-up studies highly active HIV HIV Infections - drug therapy HIV Infections - mortality Human immunodeficiency virus Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Medical Records Systems, Computerized Medical sciences Medication Adherence - statistics & numerical data patient dropouts Patient Dropouts - classification Patient Dropouts - statistics & numerical data Practice of Epidemiology ROC Curve Sensitivity and Specificity Time Factors Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Zambia Zambia - epidemiology |
| title | An Empirical Approach to Defining Loss to Follow-up Among Patients Enrolled in Antiretroviral Treatment Programs |
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