Abstract：
:Mortality assessment in cohorts with high lost to follow-up (LTFU) is challenging in settings with limited civil registration systems. We aimed to assess mortality in a clinical cohort (KIULARCO) of HIV-infected persons in rural Tanzania, accounting for unseen deaths among participants LTFU. We included adults enrolled in 2005-2015 and traced a non-random sample of those LTFU. We estimated mortality using Kaplan-Meier methods with: A) routinely-captured data; B) crudely incorporating tracing data; C) weighting using tracing data to crudely correct for unobserved deaths among participants LTFU; and D) weighting using tracing data accounting for participant characteristics. We investigated associated factors using proportional hazards models. Among 7460 adults, 646 (9%) died, 883 (12%) transferred clinics, and 2911 (39%) were LTFU. Of 2010 (69%) traced participants, 325 (16%) were found: 131 (40%) died and 130 (40%) transferred. Five-year mortality estimates were A) 13.1%; B) 16.2%; C) 36.8%; D) 35.1%. Higher mortality was associated with male sex, referral as hospital in-patient, living close to the clinic, lower body mass index, more advanced WHO stage, lower CD4 count, and less time since antiretroviral therapy initiation. Adjusting for unseen deaths among participants LTFU approximately doubled the five-year mortality estimates. Our approach is applicable to other cohorts adopting targeted tracing.
journal_name
Am J Epidemioljournal_title
American journal of epidemiologyauthors
Vanobberghen F,Weisser M,Kasuga B,Katende A,Battegay M,Tanner M,Glass TR,Kiularco Study Group OBOTdoi
10.1093/aje/kwaa176subject
Has Abstractpub_date
2020-09-05 00:00:00eissn
0002-9262issn
1476-6256pii
5901584pub_type
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