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.
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.
Authors: Didier K Ekouevi; Eric Balestre; Franck-Olivier Ba-Gomis; Serge Paul Eholie; Moussa Maiga; Clarisse Amani-Bosse; Albert Minga; Eugène Messou; Papa Salif Sow; Charlotte Lewden; Hamar Allassane Traoré; Emmanuel Bissagnene; François Dabis Journal: Trop Med Int Health Date: 2010-06 Impact factor: 2.622
Authors: Ralf Weigel; Janne Estill; Matthias Egger; Anthony D Harries; Simon Makombe; Hannock Tweya; Andreas Jahn; Olivia Keiser Journal: AIDS Date: 2012-01-28 Impact factor: 4.177
Authors: Jean B Nachega; Michael Hislop; Hoang Nguyen; David W Dowdy; Richard E Chaisson; Leon Regensberg; Mark Cotton; Gary Maartens Journal: J Acquir Immune Defic Syndr Date: 2009-05-01 Impact factor: 3.731
Authors: Rashida A Ferrand; Elizabeth L Corbett; Robin Wood; John Hargrove; Chiratidzo E Ndhlovu; Frances M Cowan; Eleanor Gouws; Brian G Williams Journal: AIDS Date: 2009-09-24 Impact factor: 4.177
Authors: Peter Cherutich; Reinhard Kaiser; Jennifer Galbraith; John Williamson; Ray W Shiraishi; Carol Ngare; Jonathan Mermin; Elizabeth Marum; Rebecca Bunnell Journal: PLoS One Date: 2012-05-04 Impact factor: 3.240
Authors: Geri R Donenberg; Mardge H Cohen; Charles Ingabire; Mary Fabri; Erin Emerson; Ashley D Kendall; Eric Remera; Olivier Manzi; Sabin Nsanzimana Journal: J Acquir Immune Defic Syndr Date: 2019-12 Impact factor: 3.731
Authors: Jillian Neary; Anjuli D Wagner; Cyrus Mugo; Peter M Mutiti; David Bukusi; Grace C John-Stewart; Dalton C Wamalwa; Pamela K Kohler; Jennifer A Slyker Journal: AIDS Care Date: 2018-09-27
Authors: L K Reif; V Rivera; R Bertrand; V Rouzier; E Kutscher; K Walsh; B Charles; J W Pape; D W Fitzgerald; S P Koenig; M L McNairy Journal: Public Health Action Date: 2018-09-21