Abstract
BackgroundWhile, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging. Using weekly cut-offs, we sought to determine the probability that an individual would return to clinic given that they had not yet returned in order to identify the LTFU cut-off that could be used to inform clinical management and tracing procedures.MethodsIndividuals who initiated ART with Dignitas International supported sites (n = 22) in Zomba, Malawi between January 1 2007-June 30 2010 and were ≥ 1 week late for a follow-up visit were included. Lateness was categorized using weekly cut-offs from ≥1 to ≥26 weeks late. At each weekly cut-off, the proportion of patients who returned for a subsequent follow-up visit were identified. Cumulative Distribution Functions (CDFs) were plotted to determine the probability of returning as a function of lateness. Hazard functions were plotted to demonstrate the proportion of patients who returned each weekly interval relative to those who had yet to return.ResultsIn total, n = 4484 patients with n = 7316 follow-up visits were included. The number of included follow-up visits per patient ranged from 1–10 (median: 1). Both the CDF and hazard function demonstrated that after being ≥9 weeks late, the proportion of new patients who returned relative to those who had yet to return decreased substantially.ConclusionsWe identified a LTFU definition useful for clinical management. The simple functions plotted here did not require advanced statistical expertise and were created using Microsoft Excel, making it a particularly practical method for HIV programs in resource-constrained settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0290-7) contains supplementary material, which is available to authorized users.
Highlights
While, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging
LTFU can be considered a general ‘catch-all’ category for patients who miss scheduled clinic visits or medication pick-ups [5], different definitions of LTFU within ART programs can have a significant impact on LTFU estimates over time [2, 4]
The hazard function in the present analysis provides insight regarding the proportion of patients who return each 1-week interval, of those who have yet to return
Summary
Lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging. LTFU can be considered a general ‘catch-all’ category for patients who miss scheduled clinic visits or medication pick-ups [5], different definitions of LTFU within ART programs can have a significant impact on LTFU estimates over time [2, 4] In their 2013 study Shepherd et al, reported that cumulative estimates of LTFU varied widely, ranging from 22 % to 84 %; this variation was primarily dependent on the definition of LTFU that was applied [4]. This, in turn, has significant implications for program planning purposes such as the development of targeted strategies to improve retention.
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