Loss to follow-up among children and adolescents growing up with HIV infection: age really matters
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Date
2017-07-17
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley Open Access
Abstract
Introduction: Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy
(ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from
childhood through adolescence.
Methods: Individuals aged 5–19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005
and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5–9
(children), 10–14 (young adolescents) and 15–19 (older adolescents). The effect of age at ART initiation, current age (using a
time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson
regression.
Results: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5–9, 10–14 and 15–19 years, respectively. Unlike those
starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older
adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94–2.55) and similarly, older adolescents had higher LTFU
rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05–3.07). In older adolescents, the LTFU rate among
those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age
(ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups.
Conclusions: Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high
risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding
how developmental heterogeneity in children affects HIV outcomes.
Description
open access journal article
Keywords
Transition, Adolescent, HIV, Africa, Lost to follow up
Citation
Kranzer K et al.(2017). Loss to follow-up among children and adolescents growing up with HIV infection: age really matters. Journal of the International AIDS Society, 20.