An empirical approach to defining loss to follow-up among patients enrolled in antiretroviral treatment programs.
Am J Epidemiol
; 171(8): 924-31, 2010 Apr 15.
Article
em En
| MEDLINE
| ID: mdl-20219765
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 > or =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.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Pacientes Desistentes do Tratamento
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Infecções por HIV
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Interpretação Estatística de Dados
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Fármacos Anti-HIV
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Humans
País/Região como assunto:
Africa
Idioma:
En
Revista:
Am J Epidemiol
Ano de publicação:
2010
Tipo de documento:
Article