Abstract：
OBJECTIVE: The objective of this study is to assess the outcomes of children, adolescents and young adults with HIV reported as lost to follow-up, correct mortality estimates for children, adolescents and young adults with HIV for unascertained outcomes in those loss to follow-up (LTFU) based on tracing and linkage data separately using data from the International epidemiology Databases to Evaluate AIDS in Southern Africa.
METHODS: We included data from two different populations of children, adolescents and young adults with HIV; (1) clinical data from children, adolescents and young adults with HIV aged ≤24 years from Lesotho, Malawi, Mozambique, Zambia and Zimbabwe; (2) clinical data from children, adolescents and young adults with HIV aged ≤14 years from the Western Cape (WC) in South Africa. Outcomes of patients lost to follow-up were available from (1) a tracing study and (2) linkage to a health information exchange. For both populations, we compared six methods for correcting mortality estimates for all children, adolescents and young adults with HIV.
RESULTS: We found substantial variations of mortality estimates among children, adolescents and young adults with HIV reported as lost to follow-up versus those retained in care. Ascertained mortality was higher among lost and traceable children, adolescents and young adults with HIV and lower among lost and linkable than those retained in care (mortality: 13.4% [traced] vs. 12.6% [retained-other Southern Africa countries]; 3.4% [linked] vs. 9.4% [retained-WC]). A high proportion of lost to follow-up children, adolescents and young adults with HIV had self-transferred (21.0% and 47.0%) in the traced and linked samples, respectively. The uncorrected method of non-informative censoring yielded the lowest mortality estimates among all methods for both tracing (6.0%) and linkage (4.0%) approaches at 2 years from ART start. Among corrected methods using ascertained data, multiple imputation, incorporating ascertained data (MI(asc.)) and inverse probability weighting with logistic weights were most robust for the tracing approach. In contrast, for the linkage approach, MI(asc.) was the most robust.
CONCLUSIONS: Our findings emphasise that lost to follow-up is non-ignorable and both tracing and linkage improved outcome ascertainment: tracing identified substantial mortality in those reported as lost to follow-up, whereas linkage did not identify out-of-facility deaths, but showed that a large proportion of those reported as lost to follow-up were self-transfers.
METHODS: We included data from two different populations of children, adolescents and young adults with HIV; (1) clinical data from children, adolescents and young adults with HIV aged ≤24 years from Lesotho, Malawi, Mozambique, Zambia and Zimbabwe; (2) clinical data from children, adolescents and young adults with HIV aged ≤14 years from the Western Cape (WC) in South Africa. Outcomes of patients lost to follow-up were available from (1) a tracing study and (2) linkage to a health information exchange. For both populations, we compared six methods for correcting mortality estimates for all children, adolescents and young adults with HIV.
RESULTS: We found substantial variations of mortality estimates among children, adolescents and young adults with HIV reported as lost to follow-up versus those retained in care. Ascertained mortality was higher among lost and traceable children, adolescents and young adults with HIV and lower among lost and linkable than those retained in care (mortality: 13.4% [traced] vs. 12.6% [retained-other Southern Africa countries]; 3.4% [linked] vs. 9.4% [retained-WC]). A high proportion of lost to follow-up children, adolescents and young adults with HIV had self-transferred (21.0% and 47.0%) in the traced and linked samples, respectively. The uncorrected method of non-informative censoring yielded the lowest mortality estimates among all methods for both tracing (6.0%) and linkage (4.0%) approaches at 2 years from ART start. Among corrected methods using ascertained data, multiple imputation, incorporating ascertained data (MI(asc.)) and inverse probability weighting with logistic weights were most robust for the tracing approach. In contrast, for the linkage approach, MI(asc.) was the most robust.
CONCLUSIONS: Our findings emphasise that lost to follow-up is non-ignorable and both tracing and linkage improved outcome ascertainment: tracing identified substantial mortality in those reported as lost to follow-up, whereas linkage did not identify out-of-facility deaths, but showed that a large proportion of those reported as lost to follow-up were self-transfers.
摘要：
目的：本研究的目的是评估儿童的结局，据报道，青少年和感染艾滋病毒的年轻人失去了随访，正确的儿童死亡率估计，青少年和年轻的艾滋病毒感染者在那些未确定的结果的随访(LTFU)基于追踪和联系数据分别使用国际流行病学数据库的数据评估南部非洲的艾滋病。
方法：我们纳入了来自两个不同儿童群体的数据，青少年和年轻人感染艾滋病毒；(1)儿童临床数据，来自莱索托的青少年和年龄≤24岁的艾滋病毒感染者，马拉维,莫桑比克,赞比亚和津巴布韦；(2)儿童临床数据，来自南非西开普省（WC）的年龄≤14岁的HIV青少年。失去随访的患者的结果可从（1）追踪研究和（2）与健康信息交换的联系中获得。对于这两个群体来说，我们比较了校正所有儿童死亡率估计的六种方法，青少年和年轻人感染艾滋病毒。
结果：我们发现儿童死亡率估计值存在很大差异，据报道,青少年和感染艾滋病毒的年轻成年人失去了随访,而不是那些被保留在护理中的人.在失踪和可追溯的儿童中，确定的死亡率更高，青少年和年轻人感染艾滋病毒，丢失和链接的比例低于保留在护理中的比例(死亡率：13.4%[追踪]vs.12.6%[保留-其他南部非洲国家]；3.4%[挂钩]与9.4%[保留-WC])。后续儿童的损失比例很高，在追踪和关联样本中，青少年和年轻的艾滋病毒感染者自我转移(21.0%和47.0%)，分别。从ART开始的2年，在追踪（6.0％）和链接（4.0％）方法的所有方法中，未校正的非信息审查方法产生的死亡率估计最低。在使用确定数据的校正方法中，多重归责,纳入确定的数据(MI(ASC.)和逻辑权重的逆概率加权对于跟踪方法是最稳健的。相比之下,对于联系方法，MI（ASC。)是最健壮的。
结论：我们的研究结果强调，随访失败是不可忽视的，并且追踪和链接都改善了结果的确定：追踪发现了报告为随访失败的患者的大量死亡率，而链接并没有识别出设施外的死亡，但表明，报告为后续行动失败的人中有很大一部分是自我转移。
方法：我们纳入了来自两个不同儿童群体的数据，青少年和年轻人感染艾滋病毒；(1)儿童临床数据，来自莱索托的青少年和年龄≤24岁的艾滋病毒感染者，马拉维,莫桑比克,赞比亚和津巴布韦；(2)儿童临床数据，来自南非西开普省（WC）的年龄≤14岁的HIV青少年。失去随访的患者的结果可从（1）追踪研究和（2）与健康信息交换的联系中获得。对于这两个群体来说，我们比较了校正所有儿童死亡率估计的六种方法，青少年和年轻人感染艾滋病毒。
结果：我们发现儿童死亡率估计值存在很大差异，据报道,青少年和感染艾滋病毒的年轻成年人失去了随访,而不是那些被保留在护理中的人.在失踪和可追溯的儿童中，确定的死亡率更高，青少年和年轻人感染艾滋病毒，丢失和链接的比例低于保留在护理中的比例(死亡率：13.4%[追踪]vs.12.6%[保留-其他南部非洲国家]；3.4%[挂钩]与9.4%[保留-WC])。后续儿童的损失比例很高，在追踪和关联样本中，青少年和年轻的艾滋病毒感染者自我转移(21.0%和47.0%)，分别。从ART开始的2年，在追踪（6.0％）和链接（4.0％）方法的所有方法中，未校正的非信息审查方法产生的死亡率估计最低。在使用确定数据的校正方法中，多重归责,纳入确定的数据(MI(ASC.)和逻辑权重的逆概率加权对于跟踪方法是最稳健的。相比之下,对于联系方法，MI（ASC。)是最健壮的。
结论：我们的研究结果强调，随访失败是不可忽视的，并且追踪和链接都改善了结果的确定：追踪发现了报告为随访失败的患者的大量死亡率，而链接并没有识别出设施外的死亡，但表明，报告为后续行动失败的人中有很大一部分是自我转移。
