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Comparison of methods to correct survival estimates and survival regression analysis on a large HIV African cohort | Journal Article / Research | MSF Science Portal
Journal Article
|Research

Comparison of methods to correct survival estimates and survival regression analysis on a large HIV African cohort

Henriques J, Pujades M, McGuire M, Szumilin E, Iwaz J, Etard JF, Ecochard R
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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.

Countries

Malawi

Subject Area

HIV/AIDS

Languages

English
DOI
10.1371/journal.pone.0031706
Published Date
23 Feb 2012
PubMed ID
22384061
Journal
PLOS One
Volume | Issue | Pages
Volume 7, Issue 2, Pages e31706
Issue Date
2012-02-23
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