Loss to follow-up trends in HIV-positive patients receiving antiretroviral treatment in Asia from 2003 to 2013

Nicole L. De La Mata, Penh S. Ly, Kinh V. Nguyen, Tuti P. Merati, Thuy T. Pham, Man P. Lee, JunYong Choi, Jeremy Ross, Matthew G. Law, Oon T. Ng

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIVpositive patients receiving ART in Asia. Methods: Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results: A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99). Conclusions: LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.

Original languageEnglish
Pages (from-to)555-562
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume74
Issue number5
DOIs
Publication statusPublished - 2017 Apr 15

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HIV
Mortality
Therapeutics
Incidence
Patient Participation
Ambulatory Care

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

De La Mata, Nicole L. ; Ly, Penh S. ; Nguyen, Kinh V. ; Merati, Tuti P. ; Pham, Thuy T. ; Lee, Man P. ; Choi, JunYong ; Ross, Jeremy ; Law, Matthew G. ; Ng, Oon T. / Loss to follow-up trends in HIV-positive patients receiving antiretroviral treatment in Asia from 2003 to 2013. In: Journal of Acquired Immune Deficiency Syndromes. 2017 ; Vol. 74, No. 5. pp. 555-562.
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abstract = "Introduction: Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIVpositive patients receiving ART in Asia. Methods: Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results: A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3{\%} (2.9{\%}-6.1{\%}) in 2003-05 to 8.1{\%} (7.1{\%}-9.2{\%}) in 2006-09 and then decreased to 6.7{\%} (5.9{\%}-7.5{\%}) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2{\%} (4.5{\%}-8.2{\%}) in 2003-05 to 3.3{\%} (2.8{\%}-3.9{\%}) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99). Conclusions: LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.",
author = "{De La Mata}, {Nicole L.} and Ly, {Penh S.} and Nguyen, {Kinh V.} and Merati, {Tuti P.} and Pham, {Thuy T.} and Lee, {Man P.} and JunYong Choi and Jeremy Ross and Law, {Matthew G.} and Ng, {Oon T.}",
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Loss to follow-up trends in HIV-positive patients receiving antiretroviral treatment in Asia from 2003 to 2013. / De La Mata, Nicole L.; Ly, Penh S.; Nguyen, Kinh V.; Merati, Tuti P.; Pham, Thuy T.; Lee, Man P.; Choi, JunYong; Ross, Jeremy; Law, Matthew G.; Ng, Oon T.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 74, No. 5, 15.04.2017, p. 555-562.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Loss to follow-up trends in HIV-positive patients receiving antiretroviral treatment in Asia from 2003 to 2013

AU - De La Mata, Nicole L.

AU - Ly, Penh S.

AU - Nguyen, Kinh V.

AU - Merati, Tuti P.

AU - Pham, Thuy T.

AU - Lee, Man P.

AU - Choi, JunYong

AU - Ross, Jeremy

AU - Law, Matthew G.

AU - Ng, Oon T.

PY - 2017/4/15

Y1 - 2017/4/15

N2 - Introduction: Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIVpositive patients receiving ART in Asia. Methods: Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results: A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99). Conclusions: LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.

AB - Introduction: Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIVpositive patients receiving ART in Asia. Methods: Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results: A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99). Conclusions: LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.

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JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

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