Adolescents living with HIV are at higher risk of death and loss to follow up from care: Analysis of cohort data from eight health facilities in Ethiopia

Abstract

BackgroundThere are limited data on the treatment outcomes of adolescents living with HIV. Our objective was to compare mortality and loss to follow up (LTFU) rates between adolescent and younger age groups at enrollment in care.MethodsThis was a retrospective cohort study carried out in eight health facilities in two regions of Ethiopia. Adolescents (age 10–14 and 15–19 year) and children (age 0–9 year) enrolled in chronic HIV care between 2005 and 2013 constituted the study population. We reviewed the individual patient charts between March and June 2014 and updated the data on the status of each patient through December 2015. We used death and loss-to-follow up as primary endpoints and used the Cox-regression analysis where age, categorized as adolescent versus child, was the main predictor variable.ResultsOf 2058 participants studied, 52.1% were adolescents. The cohort contributed 2422 person-years of observation (PYO) during the pre-ART follow-up, whereas 1531 patients put on ART contributed 5984 PYO. Of those put on ART, 209 (13.7%) LTFU and 92 (6%) deaths were reported. Adolescents in age group 15–19 yr had the highest risk of LTFU [adjusted hazard ratio, aHR (95% CI) = 3.1 2.1, 5.0 ] followed by those in age group 10–14 yr (aHR = 1.5 [0.9, 2.3]) compared with children aged 0–9 yr. Mortality hazard was significantly higher among younger adolescents (aHR = 2.8 [1.4, 5.4]) and older adolescents (aHR = 2.3 [1.1, 4.9]) compared with children.ConclusionsAdolescents are at higher risk of mortality and LTFU as compared to children ages 0–9. Younger adolescents and children had similar LTFU rates. Narrow age band disaggregated analysis can serve as useful guide for tailoring interventions to the specific needs of different age groups.

A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya

“…Finally, we found that adherence to treatment was a challenge in this cohort. This is consistent with literature regarding ALWH that demonstrate poor rates of adherence to treatment [70][71][72]. While this pilot study did not aim to assess the impact of our intervention on medication-taking, many participants reported that the WhatsApp ® groups helped them improve their adherence by establishing a peer support network.…”

Predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy in Dar es Salaam, Tanzania: a retrospective cohort study

“…There are several factors that might explain the higher mortality observed among adolescents. Previous studies have attributed these differences to structural barriers, such as restrictive laws on the age of consent for self‐care, poor linkage to CTC care and poor adherence to ART [ 15 , 23 ]. Despite the known need for protection from HIV infections and other reproductive health risks, their age and social and economic statuses limit the access of adolescents to information and services, which can lead to poor outcomes, including mortality [ 24 ].…”

“…Published data indicate that some adolescents and young adults living with HIV may die within the first year of ART initiation [ 10 , 11 , 12 , 13 ]. The predictors of mortality among adolescents and young adults living with HIV are not uniform across studies [ 7 , 14 , 15 , 16 ]. Identified predictors include low CD4 count, advanced WHO Stage clinical disease, short duration of ART, sex and age [ 7 , 14 , 15 , 16 ].…”

“…The predictors of mortality among adolescents and young adults living with HIV are not uniform across studies [ 7 , 14 , 15 , 16 ]. Identified predictors include low CD4 count, advanced WHO Stage clinical disease, short duration of ART, sex and age [ 7 , 14 , 15 , 16 ].…”

Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review

“…Unfortunately, suboptimal ART adherence is common among adolescents with HIV. While there is an overall improvement in other age groups in the epidemic control of HIV, when compared with other age categories [ 3 ], adolescents are characterized by (1) higher treatment dropout rate [ 4 , 5 ], (2) lower viral suppression achievement [ 6 ], (3) rising AIDS-related illnesses [ 5 ], and (4) a smaller decrease in AIDS-related deaths.…”