Assessing Mortality and Retention in Loss to Follow Up HIV Patients through Mortality Data Validation Protocol
The HIV care continuum provides a direct method of treatment for HIV-infected patients. Early diagnosis, linkage to care, retaining care, and antiretroviral therapy (ART) adherence can suppress HIV viral load. However, this continuum is often disrupted in the retention stage. Many factors contribute to loss to follow-up (LTFU) such as treatment cost or health facility relocation. Without routine ART regimens, LTFU patients experiences higher mortality rates than those in care, making death data crucial for health outcomes research.
For this project, we developed a protocol to detect mortality amongst LTFU patients. We use death data reported from family members, patient records, Social Security Death Index (SSDI), and National Death Index (NDI) records. This dataset includes 2,198 LTFU patients of the Vanderbilt Comprehensive Care Clinic (VCCC) and 801 known deceased patients with last-visit dates from January 1998-2015. We utilize Tennessee death records via the Shelby County Death database to match deceased LTFU patients with missed reports based on the following criteria: exact first name, last name, gender, race, death date, age at death, county of residence, and marital status. So far, we have discovered 78 matches of 1,393 LTFU patients, a 6% capture rate, which is statistically significant. Such protocol ensures valid results for assessing retention and mortality studies.
LTFU patients and deceased patients are described through the following sociodemographic factors: education, HIV risk factor, housing, income, and employment. Comparing this data to patients in care helps determine trends in LTFU/deceased patients and portray the importance of retention at the VCCC.