Retention and mortality on antiretroviral therapy in sub-Saharan Africa: Collaborative analyses of HIV treatment programmes: Collaborative

Andreas D. Haas, Elizabeth Zaniewski, Nanina Anderegg, Nathan Ford, Matthew P. Fox, Michael Vinikoor, François Dabis, Denis Nash, Jean D.Amour Sinayobye, Thêodore Niyongabo, Aristophane Tanon, Armel Poda, Adebola A. Adedimeji, Andrew Edmonds, Mary Ann Davies, Matthias Egger

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Introduction: By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. Methods: We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. Results: We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. Conclusions: Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naïve analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.

Original languageEnglish (US)
Article numbere25084
JournalJournal of the International AIDS Society
Volume21
Issue number2
DOIs
StatePublished - Feb 1 2018

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Africa South of the Sahara
HIV
Mortality
Therapeutics
Lost to Follow-Up
Databases
Central Africa
Southern Africa
Patient Transfer
Eastern Africa
Western Africa
Incidence

Keywords

  • antiretroviral therapy
  • loss to follow-up
  • mortality
  • retention
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Retention and mortality on antiretroviral therapy in sub-Saharan Africa : Collaborative analyses of HIV treatment programmes: Collaborative. / Haas, Andreas D.; Zaniewski, Elizabeth; Anderegg, Nanina; Ford, Nathan; Fox, Matthew P.; Vinikoor, Michael; Dabis, François; Nash, Denis; Sinayobye, Jean D.Amour; Niyongabo, Thêodore; Tanon, Aristophane; Poda, Armel; Adedimeji, Adebola A.; Edmonds, Andrew; Davies, Mary Ann; Egger, Matthias.

In: Journal of the International AIDS Society, Vol. 21, No. 2, e25084, 01.02.2018.

Research output: Contribution to journalArticle

Haas, AD, Zaniewski, E, Anderegg, N, Ford, N, Fox, MP, Vinikoor, M, Dabis, F, Nash, D, Sinayobye, JDA, Niyongabo, T, Tanon, A, Poda, A, Adedimeji, AA, Edmonds, A, Davies, MA & Egger, M 2018, 'Retention and mortality on antiretroviral therapy in sub-Saharan Africa: Collaborative analyses of HIV treatment programmes: Collaborative', Journal of the International AIDS Society, vol. 21, no. 2, e25084. https://doi.org/10.1002/jia2.25084
Haas, Andreas D. ; Zaniewski, Elizabeth ; Anderegg, Nanina ; Ford, Nathan ; Fox, Matthew P. ; Vinikoor, Michael ; Dabis, François ; Nash, Denis ; Sinayobye, Jean D.Amour ; Niyongabo, Thêodore ; Tanon, Aristophane ; Poda, Armel ; Adedimeji, Adebola A. ; Edmonds, Andrew ; Davies, Mary Ann ; Egger, Matthias. / Retention and mortality on antiretroviral therapy in sub-Saharan Africa : Collaborative analyses of HIV treatment programmes: Collaborative. In: Journal of the International AIDS Society. 2018 ; Vol. 21, No. 2.
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abstract = "Introduction: By 2020, 90{\%} of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. Methods: We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. Results: We included 505,634 patients: 12,848 (2.5{\%}) from Central Africa, 109,233 (21.6{\%}) from East Africa, 347,343 (68.7{\%}) from Southern Africa and 36,210 (7.2{\%}) from West Africa. In crude analyses of observed clinic data, 52.1{\%} of patients were retained on ART, 41.8{\%} were lost to follow-up and 6.0{\%} had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6{\%} of patients were retained on ART, 18.8{\%} had stopped ART and 14.7{\%} had died at 5 years. Conclusions: Improving long-term retention on ART will be crucial to attaining the 90{\%} on ART target. Na{\"i}ve analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.",
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T2 - Collaborative analyses of HIV treatment programmes: Collaborative

AU - Haas, Andreas D.

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AU - Anderegg, Nanina

AU - Ford, Nathan

AU - Fox, Matthew P.

AU - Vinikoor, Michael

AU - Dabis, François

AU - Nash, Denis

AU - Sinayobye, Jean D.Amour

AU - Niyongabo, Thêodore

AU - Tanon, Aristophane

AU - Poda, Armel

AU - Adedimeji, Adebola A.

AU - Edmonds, Andrew

AU - Davies, Mary Ann

AU - Egger, Matthias

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N2 - Introduction: By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. Methods: We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. Results: We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. Conclusions: Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naïve analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.

AB - Introduction: By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. Methods: We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. Results: We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. Conclusions: Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naïve analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.

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