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Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria
  • Published Date:
    Jun 18 2016
  • Source:
    J Adolesc Health. 59(3):298-304.


Public Access Version Available on: September 01, 2017 information icon
Please check back on the date listed above.
Details:
  • Pubmed ID:
    27329680
  • Pubmed Central ID:
    PMC5022362
  • Funding:
    R01 MH090326/MH/NIMH NIH HHS/United States
    U2G PS001058/PS/NCHHSTP CDC HHS/United States
    K23 AI106406/AI/NIAID NIH HHS/United States
    R01 AI058736/AI/NIAID NIH HHS/United States
    P30 AI060354/AI/NIAID NIH HHS/United States
  • Document Type:
  • Collection(s):
  • 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.

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