A new method to correct mortality rate biases in HIV treatment programs

Jan 18, 2011

HIV treatment programs in sub-Saharan Africa should routinely report mortality rates among patients who remain in the programs and those patients lost to follow-up, according to a study by Matthias Egger and colleagues from the International Epidemiologic Databases to Evaluate AIDS in East Africa, Western Africa, and Southern Africa that is published in this week's PLoS Medicine.

As a substantial proportion of patients in are lost to follow-up, mortality estimates for patients in these programs can be severely underestimated, so this bias needs to be taken into account when comparing the effectiveness of different programs.

The authors arrived at these conclusions by developing a nomogram (calculator) that corrects mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting antiretroviral therapy in an HIV treatment program is a weighted average of mortality among patients lost to follow-up and remaining in care.

In an accompanying Perspective, Gregory Bisson from the University of Pennsylvania School of Medicine (not involved in the research) comments that "currently we know little about the biology and behaviors that underlie loss to follow-up, but with 5.2 million people on [antiretroviral therapy], and more starting soon as a result of the 2010 WHO guidelines recommending HIV treatment earlier during disease progression, a greater understanding of loss to follow-up in its various forms is needed in order to keep the HIV treatment effort on track." He adds, "by addressing the effects of loss to follow-up on programmatic mortality estimates, and by providing monitoring efforts with a useful new tool, Egger and colleagues have helped address this need."

Explore further: Indiana HIV outbreak, hepatitis C epidemic sparks US alert

More information: Egger M, Spycher BD, Sidle J, Weigel R, Geng EH, et al. (2011) Correcting Mortality for Loss to Follow-Up: A Nomogram Applied to Antiretroviral Treatment Programmes in Sub-Saharan Africa. PLoS Med 8(1): e1000390. doi:10.1371/journal.pmed.1000390

Related Stories

Researchers urge integrating TB into HIV care

Jul 22, 2008

In resource-limited settings where tuberculosis is a major cause of mortality among HIV patients and where a multidrug-resistant TB epidemic is emerging, researchers are pressing for approaches to integrate TB prevention ...

Recommended for you

Indiana HIV outbreak, hepatitis C epidemic sparks US alert

Apr 24, 2015

Federal health officials helping to contain an HIV outbreak in Indiana state issued an alert to health departments across the U.S. on Friday, urging them to take steps to identify and track HIV and hepatitis C cases in an ...

Why are HIV survival rates lower in the Deep South than the rest of the US?

Apr 22, 2015

The Deep South region has become the epicenter of the US HIV epidemic. Despite having only 28% of the total US population, nine states in the Deep South account for nearly 40% of national HIV diagnoses. This region has the highest HIV diagnosis rates and the highest number of people living with HIV of any ...

A bad buzz: Men with HIV need fewer drinks to feel effects

Apr 20, 2015

Researchers at Yale and the VA Pittsburgh Healthcare System compared the number of drinks that men with HIV infection, versus those without it, needed to get a buzz. They found that HIV-infected men were more sensitive to ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.