Contributors: Centre for Infectious Disease Research in Zambia (CIDRZ); Centre for Infectious Disease Research; University of Alabama at Birmingham Birmingham (UAB); Indiana University; Indiana University Bloomington; Indiana University System-Indiana University System; RTI International; Research Triangle Park; The Kirby Institute; University of New South Wales Sydney (UNSW); Fundación Huésped Buenos Aires; Universität Bern = University of Bern = Université de Berne (UNIBE); Zambian Ministry of Health; Epidémiologie et Biostatistique Bordeaux; Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM); Instituto de Medicina Tropical "Alexander von Humboldt" (IMT AvH); Universidad Peruana Cayetano Heredia (UPCH); Chiang Mai University (CMU); Amo-Congo; University of California San Francisco (UC San Francisco); University of California (UC); University of Cape Town; National Institutes of Health; National Institutes of Health Bethesda, MD, USA (NIH); The International Epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration is funded jointly by the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development through the following grants: Central African region (U01AI069927), Eastern African region (U01AI069919), Southern African region (U01AI069924), Western African region (U01AI069919), Asia/Pacific region (U01AI069907), and Caribbean, Central American, and South American region (U01AI069923). The TREAT Asia HIV Observation Database, a contributor to the Asia/Pacific IeDEA region, is jointly supported by the Foundation for AIDS Research (amfAR), the Dutch Ministry of Foreign Affairs, and Stichting Aids Fonds. Additional salary and trainee support was provided by the US National Institutes of Health (D43-TW001035; P30-AI027767) and the Doris Duke Charitable Foundation (2007061); the International Epidemiologic Databases to Evaluate AIDS Collaboration
نبذة مختصرة : International audience ; BACKGROUND: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. METHODS AND FINDINGS: At a set "status classification" date, patients were categorized as either "active" or "LTFU" according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173-181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%-7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean=150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean=1.2%, 95% CI: 1.0%-1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean=19.9%, 95% CI: 19.1%-21.7%). CONCLUSIONS: Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that ...
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