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

[Guest guest]

Public release date: 18-Jan-2011

Contact: Hickling

press@...

44-122-344-2815

Public Library of Science

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

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 HIV treatment programs 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

patients remaining in care.

In an accompanying Perspective, 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. "

###

Funding: This study was supported by the US National Institute of Allergy and

Infectious Disease (NIAID, grants U01-AI069924, U01-AI069911, U01-AI069919);

Office of AIDS Research of the National Institutes of Health; the Agence

Nationale de Recherches sur le SIDA et les Hepatites Virales (ANRS), France; and

the Swiss National Science Foundation. The funders had no role in the study

design, data collection, analysis, decision to publish or preparation of the

manuscript.

Competing Interests: The authors have declared that no competing interests

exist.

Citation: 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

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE

PAPER:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000390

PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-08-01-egger.pdf

CONTACT:

Matthias Egger

University of Berne

Institute of Social and Preventive Medicine

Finkenhubelweg 11

Bern, Bern 3012

Switzerland

+41 31 631 3501

+41 31 631 3520 (fax)

egger@...

Perspective by Bisson

Competing Interests: The author has declared that no competing interests exist.

Citation: Bisson GP (2011) A Simple Novel Method for Determining Mortality Rates

in HIV Treatment Programs Worldwide. PLoS Med 8(1): e1000392.

doi:10.1371/journal.pmed.1000392

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE

PAPER:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000392

PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-08-01-bisson.pdf

CONTACT:

P.Bisson

University of Pennsylvania School of Medicine

Department of Medicine and Department of Biostatistics and Epidemiology

832 Blockley Hall

Philadelphia, PA 19104

United States of America

+1 215 573 5811

+1 215 573 5315 (fax)

bisson@...

[Guest guest]

Public release date: 18-Jan-2011

Contact: Hickling

press@...

44-122-344-2815

Public Library of Science

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

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 HIV treatment programs 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

patients remaining in care.

In an accompanying Perspective, 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. "

###

Funding: This study was supported by the US National Institute of Allergy and

Infectious Disease (NIAID, grants U01-AI069924, U01-AI069911, U01-AI069919);

Office of AIDS Research of the National Institutes of Health; the Agence

Nationale de Recherches sur le SIDA et les Hepatites Virales (ANRS), France; and

the Swiss National Science Foundation. The funders had no role in the study

design, data collection, analysis, decision to publish or preparation of the

manuscript.

Competing Interests: The authors have declared that no competing interests

exist.

Citation: 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

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE

PAPER:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000390

PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-08-01-egger.pdf

CONTACT:

Matthias Egger

University of Berne

Institute of Social and Preventive Medicine

Finkenhubelweg 11

Bern, Bern 3012

Switzerland

+41 31 631 3501

+41 31 631 3520 (fax)

egger@...

Perspective by Bisson

Competing Interests: The author has declared that no competing interests exist.

Citation: Bisson GP (2011) A Simple Novel Method for Determining Mortality Rates

in HIV Treatment Programs Worldwide. PLoS Med 8(1): e1000392.

doi:10.1371/journal.pmed.1000392

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE

PAPER:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000392

PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-08-01-bisson.pdf

CONTACT:

P.Bisson

University of Pennsylvania School of Medicine

Department of Medicine and Department of Biostatistics and Epidemiology

832 Blockley Hall

Philadelphia, PA 19104

United States of America

+1 215 573 5811

+1 215 573 5315 (fax)

bisson@...