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Training Years: 2017-2018

Training Site: Health Economics and Epidemiology Research Office (HE2RO)

Country: South Africa

Mentors: Matthew Fox DSc, MPHAudrey Pettifor, Ph.D.

Title: Are they really lost: tracking transfers and lost to follow up HIV-infected individuals through the South African National Health Laboratory Service database

Project Objectives: The goal of this research is to assess the accuracy and calculate a corrective factor for clinic-level loss to follow up estimates at 10 public health clinics in South Africa. I will build upon a cohort of 116,490 HIV-infected individuals by merging primary health center data from the 10 facilities that comprise the Right to Care Clinical Cohort with two databases- one database from the National Health Laboratory Service (NHLS) comprised of all 270,000,000 lab tests from individuals in public-sector care and one from the South African mortality registry. I will use the expanded database to evaluate health outcomes of individuals who have exited the cohort (either via transfer or loss).

Hypothesis: The proportion of people living with HIV who are virally suppressed after a known transfer is higher than the proportion virally suppressed after a silent transfer.

Aim 1: To assess the characteristics of known transfers, silent transfers, and lost to follow-up HIV infected individuals and compare outcomes (viral suppression) between known transfers and silent transfers. I will quantify the proportion of transferred and lost to follow-up HIV-infected individuals who are traceable through the NHLS database and South African mortality registry. Once classified, I will explore the characteristics (age, gender, baseline CD4, time on ART) of known transfers, silent transfers, dead, and lost to follow-up HIV-infected individuals. Additionally, I will compare viral suppression outcomes between those who notified the facility of transfer (known transfer) and those who transferred without informing the facility (silent transfer) and will explore the spatio-temporal distribution of viral suppression of transfers within South Africa.

Hypothesis: Estimates utilizing only facility-based information overestimate the number of individuals who are lost to follow-up.

Aim 2: To calculate a correction factor to more accurately estimate lost to follow-up proportions in other antiretroviral therapy programs in South Africa. I will assess the difference between naïve and corrected estimates of individuals who are classified as lost to follow-up. The naïve estimates consist of passively collected information at the clinic level while the corrected estimates consist of actively updated information based upon the outcomes from NHLS and South African mortality registry.

NIH Support: Fogarty fellowship postdoctoral training award

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