Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

Details

• Alternative Title:
  J Adolesc Health
• Personal Author:
  Ahonkhai, Aimalohi A. ; Banigbe, Bolanle ; Adeola, Juliet ; Adegoke, Abdulkabir B. ; Regan, Susan ; Bassett, Ingrid V. ; Idigbe, Ifeoma ; Losina, Elena ; Okonkwo, Prosper ; Freedberg, Kenneth A.
• Description:
  Purpose
  
  Interruptions in HIV care are a major cause of morbidity and mortality, particularly in resource-limited settings. We compared engagement in care and virologic outcomes between HIV-infected adolescents and young adults (AYA) and older adults (OA) one year after starting antiretroviral therapy (ART) in Nigeria.
  
  Methods
  
  We conducted a retrospective cohort study of AYA (15–24 years) and OA (>24 years) who initiated ART from 2009–2011. We used negative binomial regression to model the risk of inconsistent care and viremia (HIV RNA >1,000 copies/mL) among AYA and OA in the first year on ART. Regular care included monthly ART pick-up and 3-monthly clinical visits. Patients with ≤3 months between consecutive visits were considered in care. Those with inconsistent care had >3 months between consecutive visits.
  
  Results
  
  The cohort included 354 AYA and 2,140 OA. More AYA than OA were female (89% vs. 65%, p<0.001). Median baseline CD4 was 252/µL in AYA and 204/µL in OA (p=0.002). More AYA had inconsistent care than OA (55% vs. 47%, p=0.001). Adjusting for sex, baseline CD4, and education, AYA had a greater risk of inconsistent care than OA (RR 1.11, p=0.033). Among those in care after one year on ART, viremia was more common in AYA than OA (40% vs. 26% p=0.003, RR 1.53, p=0.002).
  
  Conclusions
  
  In a Nigerian cohort, AYA were at increased risk for inconsistent HIV care. Of patients remaining in care, youth was the only independent predictor of viremia at 1 year. Youth-friendly models of HIV care are needed to optimize health outcomes.
  
  
• Subjects:
  Adolescent Adult Age Factors Anti-HIV Agents Antiretroviral Therapy, Highly Active Drug Administration Schedule Female HIV Infections Humans Male Medication Adherence Nigeria Outcome Assessment, Health Care Regression Analysis Retrospective Studies Risk Factors Statistics, Nonparametric Time Factors Viral Load Viremia Young Adult

  More +
• Keywords:
  Adolescents ART HIV Inconsistent Care Older Adults Resource-limited Setting Retention Viremia Young Adults
• Source:
  J Adolesc Health. 59(3):298-304
• Pubmed ID:
  27329680
• Pubmed Central ID:
  PMC5022362
• Document Type:
  Journal Article
• Funding:
  R01 MH090326/MH/NIMH NIH HHSUnited States/ ; U2G PS001058/PS/NCHHSTP CDC HHSUnited States/ ; P30 AI060354/AI/NIAID NIH HHSUnited States/ ; K23 AI106406/AI/NIAID NIH HHSUnited States/ ; R01 AI058736/AI/NIAID NIH HHSUnited States/
• Volume:
  59
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2abe5d226202efe9e8826488b9d56ed3a36099d4dd61dc7e9e3deee3035d6a78
• Download URL:
  https://stacks.cdc.gov/view/cdc/42921/cdc_42921_DS1.pdf
• File Type:
  [PDF - 776.25 KB ]