Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013.
Year: 2014
Type: article
Abstract: Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged ≥50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p<0.001), employed (p<0.001), and married, (p<0.05 in five countries). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries in crude and multivariable analyses. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group.
Source: PubMed
Authors: Andrew F Auld, Simon G Agolory, Ray W Shiraishi, Fred Wabwire-Mangen, Gideon Kwesigabo, Modest Mulenga, Sebastian Hachizovu, Emeka Asadu, Moise Zanga Tuho, Virginie Ettiegne-Traore, Francisco Mbofana, Velephi Okello, Charles Azih, Julie A Denison, Sharon Tsui, Olivier Koole, Harrison Kamiru, Harriet Nuwagaba-Biribonwoha, Charity Alfredo, Kebba Jobarteh, Solomon Odafe, Dennis Onotu, Kunomboa A Ekra, Joseph S Kouakou, Peter Ehrenkranz, George Bicego, Kwasi Torpey, Ya Diul Mukadi, Eric van Praag, Joris Menten, Timothy Mastro, Carol Dukes Hamilton, Mahesh Swaminathan, E Kainne Dokubo, Andrew L Baughman, Thomas Spira, Robert Colebunders, David Bangsberg, Richard Marlink, Aaron Zee, Jonathan Kaplan, Tedd V Ellerbrock
Institutions: Centers for Disease Control and Prevention, Makerere University, Muhimbili University of Health and Allied Sciences, Tropical Diseases Research Centre, National Institutes of Health, Family Health International 360, Instituut voor Tropische Geneeskunde, Columbia University, Harvard University
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: National Institutes of Health
OpenAlex ID: W2206774046