dc.contributor.author | Graham, SM | |
dc.contributor.author | Raboud, J | |
dc.contributor.author | McClelland, RS | |
dc.contributor.author | Jaoko Walter G. | |
dc.contributor.author | Ndinya-Achola, JO | |
dc.contributor.author | Mandaliya, K | |
dc.contributor.author | Overbaugh, J | |
dc.contributor.author | Bayoumi, AM | |
dc.date.accessioned | 2013-04-22T13:13:58Z | |
dc.date.available | 2013-04-22T13:13:58Z | |
dc.date.issued | 2013 | |
dc.identifier.citation | PLoS One. 2013;8(3):e59480. | en |
dc.identifier.uri | www.ncbi.nlm.nih.gov/whalecom0/pubmed/23555041 | |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/16504 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595247/ | |
dc.description.abstract | OBJECTIVE:
Conventional survival estimates may be biased if loss to follow-up (LTF) is associated with the outcome of interest. Our goal was to assess whether the association between sexual risk behavior and HIV-1 acquisition changed after accounting for LTF with competing risks regression.
METHODS:
HIV-1-seronegative women who enrolled in a Kenyan sex worker cohort from 1993-2007 were followed prospectively and tested for HIV at monthly clinic visits. Our primary predictor was self-reported sexual risk behavior in the past week, analyzed as a time-dependent covariate. Outcomes included HIV-1 acquisition and LTF. We analyzed the data using Cox proportional hazards regression and competing risks regression, in which LTF was treated as a competing event.
RESULTS:
A total of 1,513 women contributed 4,150 person-years (py), during which 198 (13.1%) acquired HIV-1 infection (incidence, 4.5 per 100 py) and 969 (64.0%) were LTF (incidence, 23.4 per 100 py). After adjusting for potential confounders, women reporting unprotected sex with multiple partners were less likely to be lost to follow-up (adjusted sub-hazard ratio (aSHR) 0.50, 95% confidence interval (CI) 0.32-0.76, relative to no sexual activity). The risk of HIV-1 acquisition after reporting unprotected sex with multiple partners was similar with Cox regression (adjusted hazard ratio (aHR) 2.41, 95% CI 1.36-4.27) and competing risks regression (aSHR 2.47, 95% CI 1.33-4.58).
CONCLUSIONS:
Unprotected sex with multiple partners was associated with higher HIV-1 acquisition risk, but lower attrition. This differential attrition did not substantially bias Cox regression estimates when compared to competing risks regression results. | en |
dc.language.iso | en | en |
dc.title | Loss to Follow-Up as a Competing Risk in an Observational Study of HIV-1 Incidence | en |
dc.type | Article | en |
local.publisher | Departments of Medicine and Global Health, University of Washington, Seattle, Washington, United States of America | en |
local.publisher | Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya | en |