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Overestimates of Survival after HAART: Implications for Global Scale-Up Efforts

Author

Listed:
  • Gregory P Bisson
  • Tendani Gaolathe
  • Robert Gross
  • Caitlin Rollins
  • Scarlett Bellamy
  • Mpho Mogorosi
  • Ava Avalos
  • Harvey Friedman
  • Diana Dickinson
  • Ian Frank
  • Ndwapi Ndwapi

Abstract

Background: Monitoring the effectiveness of global antiretroviral therapy scale-up efforts in resource-limited settings is a global health priority, but is complicated by high rates of losses to follow-up after treatment initiation. Determining definitive outcomes of these lost patients, and the effects of losses to follow-up on estimates of survival and risk factors for death after HAART, are key to monitoring the effectiveness of global HAART scale-up efforts. Methodology/Principal Findings: A cohort study comparing clinical outcomes and risk factors for death after HAART initiation as reported before and after tracing of patients lost to follow-up was conducted in Botswana's National Antiretroviral Therapy Program. 410 HIV-infected adults consecutively presenting for HAART were evaluated. The main outcome measures were death or loss to follow-up within the first year after HAART initiation. Of 68 patients initially categorized as lost, over half (58.8%) were confirmed dead after tracing. Patient tracing resulted in reporting of significantly lower survival rates when death was used as the outcome and losses to follow-up were censored [1-year Kaplan Meier survival estimate 0.92 (95% confidence interval, 0.88–0.94 before tracing and 0.83 (95% confidence interval, 0.79–0.86) after tracing, log rank P

Suggested Citation

  • Gregory P Bisson & Tendani Gaolathe & Robert Gross & Caitlin Rollins & Scarlett Bellamy & Mpho Mogorosi & Ava Avalos & Harvey Friedman & Diana Dickinson & Ian Frank & Ndwapi Ndwapi, 2008. "Overestimates of Survival after HAART: Implications for Global Scale-Up Efforts," PLOS ONE, Public Library of Science, vol. 3(3), pages 1-6, March.
    • Handle: RePEc:plo:pone00:0001725
    DOI: 10.1371/journal.pone.0001725
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    References listed on IDEAS

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    1. Sydney Rosen & Matthew P Fox & Christopher J Gill, 2007. "Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review," PLOS Medicine, Public Library of Science, vol. 4(10), pages 1-11, October.
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    Cited by:

    1. Kavindhran Velen & James J Lewis & Salome Charalambous & Alison D Grant & Gavin J Churchyard & Christopher J Hoffmann, 2013. "Comparison of Tenofovir, Zidovudine, or Stavudine as Part of First-Line Antiretroviral Therapy in a Resource-Limited-Setting: A Cohort Study," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-8, May.
    2. Gregory P Bisson, 2011. "A Simple Novel Method for Determining Mortality Rates in HIV Treatment Programs Worldwide," PLOS Medicine, Public Library of Science, vol. 8(1), pages 1-2, January.

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