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Comparison of Methods for Correction of Mortality Estimates for Loss to Follow-Up after ART Initiation: A Case of the Infectious Diseases Institute, Uganda

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Listed:
  • Agnes N Kiragga
  • Barbara Castelnuovo
  • Rachel Musomba
  • Jonathan Levin
  • Andrew Kambugu
  • Yukari C Manabe
  • Constantin T Yiannoutsos
  • Noah Kiwanuka

Abstract

Background: In sub-Saharan Africa, a large proportion of HIV positive patients on antiretroviral therapy (ART) are lost to follow-up, some of whom are dead. The objective of this study was to validate methods used to correct mortality estimates for loss-to-follow-up using a cohort with complete death ascertainment. Methods: Routinely collected data from HIV patients initiating first line antiretroviral therapy (ART) at the Infectious Diseases Institute (IDI) (Routine Cohort) was used. Three methods to estimate mortality after initiation were: 1) standard Kaplan-Meier estimation (uncorrected method) that uses passively observed data; 2) double-sampling methods by Frangakis and Rubin (F&R) where deaths obtained from patient tracing studies are given a higher weight than those passively ascertained; 3) Nomogram proposed by Egger et al. Corrected mortality estimates in the Routine Cohort, were compared with the estimates from the IDI research observational cohort (Research Cohort), which was used as the “gold-standard”. Results: We included 5,633 patients from the Routine Cohort and 559 from the Research Cohort. Uncorrected mortality estimates (95% confidence interval [1]) in the Routine Cohort at 1, 2 and 3 years were 5.5% (4.9%–6.3%), 6.6% (5.9%–7.5%) and 7.4% (6.5%–8.5%), respectively. The F&R corrected estimates at 1, 2 and 3 years were 11.2% (5.8%–21.2%), 15.8% (9.9%–24.8%) and 18.5% (12.3% –27.2%) respectively. The estimates obtained from the Research Cohort were 15.6% (12.8%–18.9%), 17.5% (14.6%–21.0%) and 19.0% (15.3%–21.9%) at 1, 2 and 3 years respectively. Using the nomogram method in the Routine Cohort, the corrected programme-level mortality estimate in year 1 was 11.9% (8.0%–15.7%). Conclusion: Mortality adjustments provided by the F&R and nomogram methods are adequate and should be employed to correct mortality for loss-to-follow-up in large HIV care centres in Sub-Saharan Africa.

Suggested Citation

  • Agnes N Kiragga & Barbara Castelnuovo & Rachel Musomba & Jonathan Levin & Andrew Kambugu & Yukari C Manabe & Constantin T Yiannoutsos & Noah Kiwanuka, 2013. "Comparison of Methods for Correction of Mortality Estimates for Loss to Follow-Up after ART Initiation: A Case of the Infectious Diseases Institute, Uganda," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-7, December.
    • Handle: RePEc:plo:pone00:0083524
    DOI: 10.1371/journal.pone.0083524
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    References listed on IDEAS

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    1. Royston, Patrick & White, Ian R., 2011. "Multiple Imputation by Chained Equations (MICE): Implementation in Stata," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 45(i04).
    2. Constantine E. Frangakis & Donald B. Rubin, 2001. "Addressing an Idiosyncrasy in Estimating Survival Curves Using Double Sampling in the Presence of Self-Selected Right Censoring," Biometrics, The International Biometric Society, vol. 57(2), pages 333-342, June.
    3. Julie Henriques & Mar Pujades-Rodriguez & Megan McGuire & Elisabeth Szumilin & Jean Iwaz & Jean-François Etard & René Ecochard, 2012. "Comparison of Methods to Correct Survival Estimates and Survival Regression Analysis on a Large HIV African Cohort," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-7, February.
    4. Ming-Wen An & Constantine E. Frangakis & Beverly S. Musick & Constantin T. Yiannoutsos, 2009. "The Need for Double-Sampling Designs in Survival Studies: An Application to Monitor PEPFAR," Biometrics, The International Biometric Society, vol. 65(1), pages 301-306, March.
    5. Constantine E. Frangakis & Donald B. Rubin, 2001. "Rejoinder to Discussions on Addressing an Idiosyncrasy in Estimating Survival Curves Using Double Sampling in the Presence of Self-Selected Right Censoring," Biometrics, The International Biometric Society, vol. 57(2), pages 351-353, June.
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