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Comparison of Methods to Correct Survival Estimates and Survival Regression Analysis on a Large HIV African Cohort

Author

Listed:
  • Julie Henriques
  • Mar Pujades-Rodriguez
  • Megan McGuire
  • Elisabeth Szumilin
  • Jean Iwaz
  • Jean-François Etard
  • René Ecochard

Abstract

Objective: The evaluation of HIV treatment programs is generally based on an estimation of survival among patients receiving antiretroviral treatment (ART). In large HIV programs, loss to follow-up (LFU) rates remain high despite active patient tracing, which is likely to bias survival estimates and survival regression analyses. Methods: We compared uncorrected survival estimates derived from routine program data with estimates obtained by applying six correction methods that use updated outcome data by a field survey targeting LFU patients in a rural HIV program in Malawi. These methods were based on double-sampling and differed according to the weights given to survival estimates in LFU and non-LFU subpopulations. We then proposed a correction of the survival regression analysis. Results: Among 6,727 HIV-infected adults receiving ART, 9% were LFU after one year. The uncorrected survival estimates from routine data were 91% in women and 84% in men. According to increasing sophistication of the correction methods, the corrected survival estimates ranged from 89% to 85% in women and 82% to 77% in men. The estimates derived from uncorrected regression analyses were highly biased for initial tuberculosis mortality ratios (RR; 95% CI: 1.07; 0.76–1.50 vs. 2.06 to 2.28 with different correction weights), Kaposi sarcoma diagnosis (2.11; 1.61–2.76 vs. 2.64 to 3.9), and year of ART initiation (1.40; 1.17–1.66 vs. 1.29 to 1.34). Conclusions: In HIV programs with high LFU rates, the use of correction methods based on non-exhaustive double-sampling data are necessary to minimise the bias in survival estimates and survival regressions.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0031706
    DOI: 10.1371/journal.pone.0031706
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    References listed on IDEAS

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    1. 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.
    2. Martin W G Brinkhof & Mar Pujades-Rodriguez & Matthias Egger, 2009. "Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 4(6), pages 1-9, June.
    3. 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.
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    1. 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.

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