title: Outcomes of HIV-positive patients lost to follow-up in African treatment programmes.
abstract: The retention of patients on antiretroviral therapy (ART) is key to achieving global targets in response to the HIV epidemic. Loss to follow-up (LTFU) can be substantial, with unknown outcomes for patients lost to ART programmes. We examined changes in outcomes of patients LTFU over calendar time, assessed associations with other study and programme characteristics and investigated the relative success of different tracing methods.
  
  
  
  We performed a systematic review and logistic random-effects meta-regression analysis of studies that traced adults or children who started ART and were LTFU in sub-Saharan African treatment programmes. The primary outcome was mortality, and secondary outcomes were undocumented transfer to another programme, treatment interruption and the success of tracing attempts.
  
  
  
  We included 32 eligible studies from 12 countries in sub-Saharan Africa: 20 365 patients LTFU were traced, and 15 708 patients (77.1%) were found. Compared to telephone calls, tracing that included home visits increased the probability of success: the adjusted odds ratio (aOR) was 9.35 (95% confidence interval [CI] 1.85-47.31). The risk of death declined over calendar time (aOR per 1-year increase 0.86, 95% CI 0.78-0.95), whereas undocumented transfers (aOR 1.13, 95% CI 0.96-1.34) and treatment interruptions (aOR 1.31, 95% CI 1.18-1.45) tended to increase. Mortality was lower in urban than in rural areas (aOR 0.59, 95% CI 0.36-0.98), but there was no difference in mortality between adults and children. The CD4 cell count at the start of ART increased over time.
  
  
  
  Mortality among HIV-positive patients who started ART in sub-Saharan Africa, were lost to programmes and were successfully traced has declined substantially during the scale-up of ART, probably driven by less severe immunodeficiency at the start of therapy.
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Zürcher
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Mooser
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Nanina
authors.initials: N
authors.lastname: Anderegg
authors.affiliation: Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.|Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Tymejczyk
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Couvillon
authors.affiliation: Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.|Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.|Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D003695:Delivery of Health Care; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D059012:Lost to Follow-Up
chemical_list: D019380:Anti-HIV Agents
keywords: 
  VIH
  ; Afrique subsaharienne; HIV; antiretroviral therapy; loss to follow-up; mortalidad; mortality; mortalité; perte au suivi; pérdida durante el seguimiento; sub-Saharan Africa; terapia antirretroviral; thérapie antirétrovirale; África subsahariana