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Losses to follow-up in 3 Central African country non-PEPFAR ART delivery programs
J. Atibu Losoma1, M. Kiumbu2, I. Azinyue3, H. Mukumbi2, R. Ryder4
1UNC-DRC Project, IeDEA Region 9, Kinshasa, Congo, the Democratic Republic of the, 2Amocongo, Kinshasa, Congo, the Democratic Republic of the, 3IeDEA-Cameroon, Yaounde, Cameroon, 4University of California, San Diego, United States
Background: A key component of the evaluation of the impact of ART Delivery Programs is the estimation of survival of patients under care. ART Delivery Program activities primarily involve outpatient care that monitors mortality passively. A major obstacle for appropriate ART Delivery Programs is patient loss to follow up, which occurs at rates as high as 59%. Moreover, there is some evidence that standard analytic methods produce biased results in the sense that the individuals lost-to-follow up are generally sicker than those who stay in the study. Thus, estimates derived from passively monitored programs may seriously underestimate patient mortality.
Methods: Random sampling of longitudinal cohort studies of patients on ART in Cameroon, Democratic Republic of Congo and Burundi who have been lost for >6 months since their last clinic visit
Results: . Cumulative incidence of death among lost patients was highDuring ~5000 patient years of follow-up, rates of lost to follow-up >6 months since last clinic visit have been similarly high (35% in DRC, 38% in Burundi and 27% in Cameroon) in the seven ART Delivery Program cohorts we are currently following. Most common reasons for missing a clinic appointment were; no transportation available to the clinic, not enough money for transportation, had to work, had to take care of children. Unknown transfers represented the majority of those lost to follow- up. Rate of death was highest soon after last clinic visit.
Conclusions: Visiting homes, a rarely used feature in ART treatment cohorts in industrialized countries, is a key procedure in sub-Saharan Africa.
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