Patient Mortality Outcome Estimates

Once revised mortality outcome estimates identified through BetterInfo tracking of LTFU patients were included in the data collected at the health facility, a higher, but more accurate mortality rate estimate was ascertained. Routine HIV Care and Treatment program monitoring underestimated the mortality of ART patients markedly, thereby threatening to undermine assessment of its public health effectiveness. The underestimation of mortality was mainly because ART patient deaths which occurred in the community were not always reported to the health facility. Therefore, the 2% mortality at 2 years is a reflection of only the deaths which were entered in the EMRS and occurred at the health facilities.

Mortality Outcome Estimates in New ART Initiator Patients - Figure 1

  • Using only data from the EMRS, the patient mortality estimated across all sites was 1% at one year and 2% at two years post ART initiation.
  • Median site-level mortality among the "lost" across the 30 BetterInfo sites was 12% (IQR 8% to 17%, range 4% to 27%).

REVISED Mortality Outcome Estimates in New ART Initiator Patients - Figure 1

  • Once the revised outcome estimates among the lost were incorporated, overall estimates of mortality in the entire cohort of patients starting ART increased to roughly 5% at 1 year and 8% at 2 years.
  • Median site level mortality across the 30 sites was 9% (IQR: 5% to 15%, range 3% to 19%).

Figure 1: Naive and Revised Outcome Estimates in New ART Initiator Patients

Naive Outcome Estimates in New ART Initiator Patients Revised Outcome Estimates in New ART Initiator Patients