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Problem In many resource-poor countries that are scaling up antiretroviral therapy (ART), 5-25% of patients are reported as "lost to follow-up". This figure is 9% in Malawi. There is no published information about the true outcome status of these patients. Approach In four facilities in northern Malawi, ART registers and master cards were used to identify patients who had not attended the facility for 3 months or more and were thus registered as "lost to follow-up". Clinic staff attempted to trace these patients and ascertain their true outcome status. Local setting Of 253 patients identified as "lost to follow-up", t27 (50%) were dead, 58% of these having died within 3 months of their last clinic visit. Of the 58 patients (23%) found to be alive, 21 were still receiving ART and 37 had stopped treatment (high transport costs being the main reason for 13 patients). Sixty-eight patients (27%) could not be traced, most commonly because of an incorrect address in the register. Fewer patients were alive and more patients could not be traced from the central hospital compared with the peripheral hospitals. Relevant changes Better documentation of patients&apos; addresses and prompt follow-up of patients who are late for their appointments are required. Lessons learned ART clinics in resource-poor countries should ensure that patients&apos; addresses are correct and comprehensive. Clinics should also undertake contact tracing as soon as possible in the event of non-attendance, consider facilitating access to ART clinics and take loss to follow-up into consideration when assessing death rates. Problematique Dans nombre de pays a revenu modeste qui ont entrepris d&apos;etendre le traitement antiretroviral (ART), 5 a 25 % des patients sont signales comme << perdus de vue >>. Ce chiffre est de 9% pour le Malawi. On ne dispose pas de donnees publiees sur la veritable issue pour ces patients. Demarche Dans quatre etablissements de la partie nord du Malawi, on a utilise les livres-registres de delivrance des ART et les cartes maitresses pour identifier les patients ne s&apos;etant pas rendu dans l&apos;etablissement depuis 3 mois ou plus et enregistres ainsi comme << perdus de vue >>. Le personnel clinique s&apos;est attache a retrouver la trace de ces patients et a determiner l&apos;issue veritable du traitement dans leur cas. Contexte local Sur 253 patients classes comme << perdus de vue >>, 127 (50 %) etaient morts et parmi ces patients decedes, 58 % avaient perdu la vie dans les 3 mois suivant leur derniere visite au dispensaire. Parmi les 58 patients retrouves en vie (23 %), 21 prenaient encore des antiretroviraux et 37 avaient interrompu leur traitement (les couts excessif du transport etant la principale raison de cet arret pour 13 d&apos;entre eux). Soixante-huit patients (27 %) n&apos;on pu etre retrouves, le plus souvent a cause de l&apos;inexactitude de l&apos;adresse enregistree dans leur dossier. Peu des patients perdus de vue etaient encore en vie et le nombre des patients impossibles a retrouver etait plus important pour l&apos;hopital central que pour les etablissements peripheriques. Modifications pertinentes II convient de relever avec plus de rigueur l&apos;adresse des patients et d&apos;entreprendre rapidement un suivi de ceux qui tardent a se presenter aux rendez-vous. Enseignements tires Les etablissements delivrant les traitements ART dans les pays a faible revenu doivent s&apos;assurer de l&apos;exactitude et de la completude de l&apos;adresse qu&apos;ils enregistrent pour leurs patients. Ils doivent aussi entreprendre des que possible une recherche des contacts si un patient ne se presente plus aux rendez-vous, envisager de faciliter l&apos;acces au lieu de delivrance du traitement ART et prendre en compte les << perdus de vue >> dans l&apos;evaluation des taux de mortalite. Problema En muchos paises con recursos escasos que estan extendiendo masivamente la terapia antirretroviral (TAR) se informa de que un 5%-25% de los pacientes tratados se pierde en el seguimiento. En Malawi el porcentaje es del 9%. No hay datos publicados sobre la verdadera evolucion de esos pacientes. Metodos En cuatro establecimientos del norte de Malawi, se utilizaron los registros de TAR y las tarjetas maestras para identificar a los pacientes que no habian acudido al establecimiento durante 3 o mas meses y estaban registrados por tanto como <>. Trabajadores de esos centros intentaron localizar a los pacientes y evaluar su estado de salud real. Contexto local De 253 pacientes identificados como <>, 127 (50%) habian muerto, el 58% de ellos en los 3 meses siguientes a su uItima visita al consultorio. De los 58 pacientes (23%) hallados con vida, 21 seguian recibiendo TAR y 37 habian interrumpido el tratamiento (13 de ellos adujeron como causa principal el alto precio de los transportes). Sesenta y ocho pacientes (27%) no pudieron ser localizados, fundamentalmente porque en los registros figuraba una direccion incorrecta. En comparaciOn con los hospitales perifericos, en el caso del hospital central habia menos pacientes vivos y mas a los que no se pudo localizar. Cambios destacables Es necesario registrar mejor las direcciones de los pacientes y reanudar rapidamente el seguimiento de los que falten a las citas concertadas. Ensefianzas resultantes Los consultorios de TAR de los paises de recursos escasos deben procurar que las direcciones de sus pacientes se registren correctamente y sin omisiones. Los consultorios deben adoptar ademas lo antes posible medidas de localizacion de contactos en caso de no asistencia, estudiar la manera de facilitar el acceso a Ios consultorios de TAR, y tener en cuenta las perdidas en el seguimiento a la hora de evaluar las tasas de mortalidad., Introduction Many resource-poor countries with HIV epidemics are scaling up antiretroviral therapy (ART). By December 2005, an estimated 1.3 million people from low-and middle-income countries had been placed on treatment; [...]

Abstract Background Few studies have examined the longitudinal changes in the patterns, selection, and utilization of treatments for chronic myeloid leukemia (CML) in routine clinical practice since the introduction of imatinib. Therefore, we investigated the trends in CML therapy, including changes, patterns, and persistence to imatinib therapy among patients with newly diagnosed CML. Methods We conducted a cross-sectional and longitudinal analysis of 11 years of claims data for patients with newly diagnosed CML included in the Taiwan National Health Insurance program. Pharmacy and diagnosis claims for newly diagnosed CML recorded between 1997 and 2007 year were extracted from the database. Annual overall use, new use of CML therapy, and persistence to imatinib therapy were estimated. The Anatomical Therapeutic Chemical codes for CML therapy [i.e., imatinib and conventional therapy: busulfan, hydroxyurea, interferon-α (IFNα), and cytarabine], and the process code for hematopoietic stem cell transplantation were used to categorize treatment patterns. Associations with patients characteristics were analyzed by multivariate logistic regression. Results Overall, the proportion of patients with newly diagnosed CML to all patients with CML increased by approximately 4-fold between 1998 and 2007. There were steady increases in the proportions of all treated patients and those starting therapy from 2003 to 2007. Fewer comorbid conditions and lower severity of CML were associated with treatment initiation. Medication persistence varied according to treatment duration, as 38.7% patients continued imatinib for ≥ 18 months without interruption but only 7.7% continued imatinib for ≥ 5 years. Factors associated with persistence to imatinib therapy were removal of the need for prior authorization for imatinib, and prior use of hydroxyurea and IFNα, whereas having undergone hematopoietic stem cell transplantation led to reduced likelihood of persistence to imatinib therapy. Conclusion Treatment decisions for patients with CML changed over time in routine clinical practice. Our findings suggest that clinicians are increasingly adopting the recommendations of international treatment guidelines for CML. However, persistence to imatinib therapy is still substantially below the recommended level based on current evidence for its efficacy. Our study also highlights the need to improve treatment persistence and effectiveness of imatinib over the long term.

Abstract Background Infectious agents have been shown to contribute to the development of lymphoid malignancies. The different distribution of lymphoid malignancies in Asian and Western populations suggests possibly different etiologies in Asian populations. Herpes zoster infection, commonly seen in immunocompromised persons, has been reported to be associated with lymphoid malignancies in retrospective case–control studies from Western populations, but the results are controversial and large-scale prospective studies from Asian populations are lacking. Methods A nationwide population-based matched-controlled prospective study on Taiwanese patients was performed using the National Health Insurance Research Database from 1996 to 2007. Herpes zoster and malignancies were defined by compatible ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification) codes. Patients who had been diagnosed with any malignancies before herpes zoster, with known viral infections including human immunodeficiency virus, and duration from herpes zoster to diagnosis of malignancies less than 6 months were excluded. Results Of 42,498 patients with herpes zoster prior to the diagnosis of any malignancies, the cumulative incidence for lymphoid malignancies was 0.11% (n = 48), compared with 0.06% (n = 106) in 169,983 age- and gender-matched controls (univariate hazard ratio (HR): 1.82, 95%CI: 1.29-2.55). The most common lymphoid malignancy was non-Hodgkin’s lymphoma (60.4%, n = 29), followed by multiple myeloma (27.1%, n = 13). Risk for developing lymphoid malignancies is significantly higher in herpes zoster patients (log rank P = 0.005). After adjusting for presence of any comorbidities in Charlson comorbidity index, time-dependent covariate for herpes group, and income category using Cox proportional hazard regressions, herpes zoster patients had an increased risk of developing lymphoid malignancies (adjusted HR: 1.68, 95%CI: 1.35-2.42, P = 0.0026), but did not have an increased risk of developing non-lymphoid malignancies (adjusted HR: 1.00, 95%CI: 0.91-1.05, P = 0.872). Conclusion Preceding herpes zoster infection is an independent risk marker for subsequent lymphoid malignancies in Taiwanese subjects. Further studies are warranted for pathogenesis exploration and preventive strategies in Asian populations.