Machine Learning Outperforms Cox Model For ART

Researchers compared Cox proportional hazards and multiple machine learning models using longitudinal EMR data from 621,115 Kenyan patients who started ART between 2017 and 2023. Recursive partitioning achieved the highest concordance-index scores—0.81 for first treatment interruptions and 0.89 for multiple interruptions—versus the CPH model's 0.78 and 0.87. Model-agnostic explainers (SHAP, breakdown, ceteris paribus) provided global and individual risk insights to support targeted retention interventions.