Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis
AffiliationDivision of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Epicentre, Médecins Sans Frontières, Paris, France; Department of Social Medicine, University of Bristol, Bristol, United Kingdom
MetadataShow full item record
AbstractBACKGROUND: The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes. METHODS AND FINDINGS: We searched the PubMed, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Indian Medlars Centre (IndMed) and African Index Medicus (AIM) databases and the abstracts of three conferences for studies that traced patients lost to follow up to ascertain their vital status. Main outcomes were the proportion of patients traced, the proportion found to be alive and the proportion that had died. Where available, we also examined the reasons why some patients could not be traced, why patients found to be alive did not return to the clinic, and the causes of death. We combined mortality data from several studies using random-effects meta-analysis. Seventeen studies were eligible. All were from sub-Saharan Africa, except one study from India, and none were conducted in children. A total of 6420 patients (range 44 to 1343 patients) were included. Patients were traced using telephone calls, home visits and through social networks. Overall the vital status of 4021 patients could be ascertained (63%, range across studies: 45% to 86%); 1602 patients had died. The combined mortality was 40% (95% confidence interval 33%-48%), with substantial heterogeneity between studies (P<0.0001). Mortality in African programmes ranged from 12% to 87% of patients lost to follow-up. Mortality was inversely associated with the rate of loss to follow up in the programme: it declined from around 60% to 20% as the percentage of patients lost to the programme increased from 5% to 50%. Among patients not found, telephone numbers and addresses were frequently incorrect or missing. Common reasons for not returning to the clinic were transfer to another programme, financial problems and improving or deteriorating health. Causes of death were available for 47 deaths: 29 (62%) died of an AIDS defining illness. CONCLUSIONS: In ART programmes in resource-limited settings a substantial minority of adults lost to follow up cannot be traced, and among those traced 20% to 60% had died. Our findings have implications both for patient care and the monitoring and evaluation of programmes.
- Self-transfer and mortality amongst adults lost to follow-up in ART programmes in low- and middle-income countries: systematic review and meta-analysis.
- Authors: Wilkinson LS, Skordis-Worrall J, Ajose O, Ford N
- Issue date: 2015 Mar
- Outcomes of HIV-positive patients lost to follow-up in African treatment programmes.
- Authors: Zürcher K, Mooser A, Anderegg N, Tymejczyk O, Couvillon MJ, Nash D, Egger M, IeDEA and MESH consortia.
- Issue date: 2017 Apr
- Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis.
- Authors: Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, Keiser O, IeDEA Southern Africa.
- Issue date: 2012 Dec
- Adjusting mortality for loss to follow-up: analysis of five ART programmes in sub-Saharan Africa.
- Authors: Brinkhof MW, Spycher BD, Yiannoutsos C, Weigel R, Wood R, Messou E, Boulle A, Egger M, Sterne JA, International epidemiological Database to Evaluate AIDS (IeDEA).
- Issue date: 2010 Nov 30
- Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings.
- Authors: Forster M, Bailey C, Brinkhof MW, Graber C, Boulle A, Spohr M, Balestre E, May M, Keiser O, Jahn A, Egger M, ART-LINC collaboration of International Epidemiological Databases to Evaluate AIDS.
- Issue date: 2008 Dec