CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Conclusions: Among large number of patients who initiated ART, one-year mortality rates after ART initiation declined after country-level implementation of WHO 2010 treatment guidelines at rates greater than secular trends in mortality.

1021 Declining Mortality in Patients on ART Lost to Follow-up in Sub-Saharan Africa Matthias Egger 1 ; Anne Mooser 1 ; Kathrin Zürcher 1 ; Denis Nash 2 ; OlgaTymejczyk 2 ; Margaret Couvillon 1 ; for the IeDEA and MESH Consortia 1 Univ of Bern, Bern, Switzerland; 2 Sch of PH, City Univ of New York, New York, NY, USA

Background: Mortality is high in patients lost to HIV treatment and care programs in sub-Saharan Africa, but may have declined with the continued scale up of facilities providing antiretroviral therapy (ART). We did a systematic review and meta-regression analysis of studies of vital status in patients on antiretroviral therapy (ART) who were lost to follow- up. Methods: We searched the Medline, Embase, and African Index Medicus (AIM) databases and the abstracts of CROI and IAS conferences for studies that traced patients lost to follow up during the scale-up of ART in sub-Saharan Africa. Mortality in patients successfully traced was the main outcome. Transfers to other clinics and the CD4 cell count at the start of ART were also analyzed. We used random-effects meta-(regression) models to examine trends over time. Results: We identified 59 studies (34 articles, 24 conference presentations) published 2005-2015, including 6 studies in children. Loss to follow-up was typically defined as not having returned to the clinic for >3 months after a missed appointment. A total of 47,530 patients were traced using telephone calls, home visits, social networks or, in the Republic of South Africa, by linkage to the mortality registry. The vital status of 26,730 (56.2%) patients lost to follow-up could be ascertained. Overall 9,105 (34.1%) patients had died. Among those alive, 4,049 (21.2%) had transferred to another facility. Mortality decreased over time, from around 40% in 2003 to 8% in 2012 (Figure). In meta-regression mortality declined by 3.9% per year (95% CI 2.1% to 5.7%, p<0.001). Trends were similar in adults and children. The median CD4 count at the start of ART increased by around 10 cells per year both in patients lost to follow up (11.6 cells; 95% CI 1.6-21.6; p=0.028) and in all patients (10.2 cells; 95% CI 4.0-16.4, p=0.005). No change over time in transfers to other clinics over time was noted (p=0.79). Conclusions: Mortality in patients lost to follow-up has declined substantially with the scale up of ART in sub-Saharan Africa. The decline in mortality appears to be explained by earlier start of ART, with higher CD4 cell counts, rather than by an increase in silent transfers to other ART providers.

Poster Abstracts

1022 Lost to Found: The Silent Transfer of Antiretroviral Therapy Patients in South Africa Claudine M. Hennessey 1 ; Andrew Boulle 2 ; Kathryn Stinson 2 ; Mariette Smith 1 ; Gilles Van Cutsem 1 Univ of Cape Town, Cape Town, South Africa; 2 Cntr for Infectious Disease Epi and Rsr, Cape Town, South Africa

Background: Incorrect reporting of Lost to Follow-up (LTF) patients who silently transfer (STF) to another health facility negatively affects the ART program’s retention in care (RIC) figures. Identifying the proportion of LTF patients who STF and the reasons patients STF is a priority in order to ensure patient continuity of care, improve policy and treatment guidelines, and provide accurate ART programme outcomes. Methods: A mixed methods approach was conducted using quantitative and qualitative data sourced from an ART longitudinal electronic patient monitoring system and patient and healthcare provider (HCP) interviews. Adults on ART with a LTF outcome between 2008 and 2012 were included. Thirty patient and five HCP interviews were completed. Results: Of the 4182 patients identified as LTF 36%were identified as STF. Sixty-eight percent were female and 51%were between 25-34 years of age. Eighty-four percent transferred once with a mean time to transfer of 870 days from ART start.

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CROI 2016