Details:

Alternative Title:
AIDS
Publisher's site:
http://dx.doi.org/10.1097/QAD.0000000000000054
Personal Author:
Lamb, Matthew R. ; Fayorsey, Ruby ; Nuwagaba-Biribonwoha, Harriet ; Viola, Violante ; Mutabazi, Vincent ; ... More +
Lamb, Matthew R. ; Fayorsey, Ruby ; Nuwagaba-Biribonwoha, Harriet ; Viola, Violante ; Mutabazi, Vincent ; Alwar, Teresa ; Casalini, Caterina ; Elul, Batya Less -
Description:
Objectives

To compare pre and post-ART attrition between youth (15–24 years) and other patients in HIV care, and to investigate factors associated with attrition among youth.

Design

Cohort study utilizing routinely collected patient-level data from 160 HIV clinics in Kenya, Mozambique, Tanzania, and Rwanda.

Methods

Patients at least 10 years of age enrolling in HIV care between 01/05 and 09/10 were included. Attrition (loss to follow-up or death 1 year after enrollment or ART initiation) was compared between youth and other patients using multivariate competing risk (pre-ART) and traditional (post-ART) Cox proportional hazards methods accounting for within-clinic correlation. Among youth, patient-level and clinic-level factors associated with attrition were similarly assessed.

Results

A total of 312 335 patients at least 10 years of age enrolled in HIV care; 147 936(47%) initiated ART, 17% enrolling in care and 10% initiating ART were youth. Attrition before and after ART initiation was substantially higher among youth compared with other age groups. Among youth, nonpregnant women experienced lower pre-ART attrition than men [sub-division hazard ratio=0.90, 95% confidence interval (CI): 0.86–0.94], while both pregnant [adjusted hazard ratio (AHR) = 0.85, 95% CI: 0.74–0.97] and nonpregnant (AHR = 0.79, 95% CI: 0.73–0.86) female youth experienced lower post-ART attrition than men. Youth attending clinics providing sexual and reproductive health services including condoms (AHR = 0.47, 95% CI: 0.32–0.70) and clinics offering adolescent support groups (AHR = 0.73, 95% CI: 0.52–1.0) experienced significantly lower attrition after ART initiation.

Conclusion

Youth experienced substantially higher attrition before and after ART initiation compared with younger adolescents and older adults. Adolescent-friendly services were associated with reduced attrition among youth, particularly after ART initiation.


Subjects:
[+]
Adolescent Adult Ambulatory Care Anti-Retroviral Agents Antiretroviral Therapy, Highly Active Child Cohort Studies Female HIV Infections Humans Incidence Lost To Follow-Up Male Middle Aged Pregnancy Young Adult
Source:
AIDS. 2014; 28(4):559-568.
Pubmed ID:
24076661
Pubmed Central ID:
PMC4517438
Document Type:
Journal Article
Funding:
5U2GPS001537-03/PHS HHS/United States ; U2G PS001537/PS/NCHHSTP CDC HHS/United States
5U2GPS001537-03/PHS HHS/United States ; U2G PS001537/PS/NCHHSTP CDC HHS/United States Less -
Place as Subject:
Africa
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:d6018559f9399bf9de465f28c27921ae609599ea9301cab3a7cd34f1dde0a686
Download URL:
https://stacks.cdc.gov/view/cdc/32460/cdc_32460_DS1.pdf
File Type:

Supporting Files

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