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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
High attrition before and after ART initiation among youth (15-24 years of age) enrolled in HIV care
AIDS, Volume 28, No. 4, Year 2014
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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 312S335 patients at least 10 years of age enrolled in HIV care; 147S936 (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 ratioS=S0.90, 95% confidence interval (CI): 0.86-0.94], while both pregnant [adjusted hazard ratio (AHR)S=S0.85, 95% CI: 0.74-0.97] and nonpregnant (AHRS=S0.79, 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 (AHRS=S0.47, 95% CI: 0.32-0.70) and clinics offering adolescent support groups (AHRS=S0.73, 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. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Lamb, Matthew R.
United States, New York
Columbia University
United States, New York
Mailman School of Public Health
Fayorsey, Ruby N.
United States, New York
Columbia University
Nuwagaba-Biribonwoha, Harriet
United States, New York
Columbia University
Viola, Violante
United States, New York
Columbia University
Mutabazi, Vincent
Rwanda, Kigali
Rwanda Biomedical Centre
Alwar, Terezah
United States, New York
Columbia University
Casalini, Caterina
United States, New York
Columbia University
Elul, Batya
United States, New York
Columbia University
United States, New York
Mailman School of Public Health
Statistics
Citations: 174
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1097/QAD.0000000000000054
e-ISSN:
14735571
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Kenya
Mozambique
Rwanda
Tanzania
Participants Gender
Male
Female