Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

Ahonkhai, Aimalohi A.; Banigbe, Bolanle; Adeola, Juliet; Adegoke, Abdulkabir B.; Regan, Susan; Bassett, Ingrid V.; Idigbe, Ifeoma; Losina, Elena; Okonkwo, Prosper; Freedberg, Kenneth A.

doi:10.1016/j.jadohealth.2016.05.002

Cited by 23 publications

(26 citation statements)

References 34 publications

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“…These all provide re-assurance that stable patients can be safely shifted to less intensive follow up without compromising their clinical outcomes, making life long disease management more efficient for patients and freeing up valuable clinician time for patients requiring more intense follow-up or those being newly initiated. We observed an increased risk of LTFU and viral rebound in younger patients; a finding that has been demonstrated in other studies [14,[20][21][22][23][24]. Poor outcomes for young people are not limited to models of differentiated care or HIV.…”

Section: Discussionsupporting

confidence: 84%

High rates of retention and viral suppression in the scale‐up of antiretroviral therapy adherence clubs in Cape Town, South Africa

Tsondai

Wilkinson

Grimsrud³

et al. 2017

Journal of the International AIDS Society

103

127

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Introduction: Increasingly, there is a need for health authority scale up of successfully piloted differentiated models of antiretroviral therapy (ART) delivery. However, there is a paucity of evidence on system-wide outcomes after scale-up. In the Cape Town health district, stable adult patients were referred to adherence clubs (ACs) – a group model of ART delivery with five visits per year. By the end of March 2015, over 32,000 ART patients were in an AC. We describe patient outcomes of a representative sample of AC patients during this scale-up.Methods: Patients enrolled in an AC at non-research supported sites between 2011 and 2014 were eligible for analysis. We sampled 10% of ACs (n = 100) in quintets proportional to the number of ACs at each facility, linking each patient to city-wide laboratory and service access data to validate retention and virologic outcomes. We digitized registers and used competing risks regression and cross-sectional methods to estimate outcomes: mortality, transfers, loss to follow-up (LTFU) and viral load suppression (≤400 copies/mL). Predictors of LTFU and viral rebound were assessed using Cox proportional hazards models.Results: Of the 3216 adults contributing 4019 person years of follow-up (89% in an AC, median 1.1 years), 70% were women. Retention was 95.2% (95% CI, 94.0-96.4) at 12 months and 89.3% (95% CI, 87.1-91.4) at 24 months after AC enrolment. In the 13 months prior to analysis closure, 88.1% of patients had viral load assessments and of those, viral loads ≤400 copies/mL were found in 97.2% (95% CI, 96.5-97.8) of patients. Risk of LTFU was higher in younger patients and in patients accessing ART from facilities with larger ART cohorts. Risk of viral rebound was higher in younger patients, those that had been on ART for longer and patients that had never sent a buddy to collect their medication.Conclusions: This is the first analysis reporting patient outcomes after health authorities scaled-up a differentiated care model across a high burden district. The findings provide substantial reassurance that stable patients on long-term ART can safely be offered care options, which are more convenient to patients and less burdensome to services.

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Section: Discussionsupporting

confidence: 84%

High rates of retention and viral suppression in the scale‐up of antiretroviral therapy adherence clubs in Cape Town, South Africa

Tsondai

Wilkinson

Grimsrud³

et al. 2017

Journal of the International AIDS Society

103

127

View full text Add to dashboard Cite

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“…The age-related rapid change of cognitive, psychosocial and psychomotor development calls for an analytic approach using narrow age-bands such as those used in our study. Data for children and adolescents have been analysed in a variety of ways categorizing children and adolescents into variably aggregated age-bands in comparison with adults, for example, adolescents (10-19 years) [25], children (<15 years) [14] and youth (15-24 years) [26]. Careful consideration to decide how best to categorize persons in the 0-24 year age group is needed.…”

Section: Discussionmentioning

confidence: 99%

Loss to follow‐up among children and adolescents growing up with HIV infection: age really matters

Kranzer

Bradley

Musaazi

et al. 2017

Journal of the International AIDS Society

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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.

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“…Nonetheless, the characteristics of the study participants are similar to other studies among young people Nigeria. These studies also recorded more female participants to male participants [36][37][38][39] and most of the young people had completed at least secondary school education [37,40]. Another limitation is the social desirability response bias [41] or the possibility that some young people may have provided more socially acceptable responses, thus minimizing reporting their sexual and HIV testing history [42].…”

Section: Discussionmentioning

confidence: 99%

Preferences for HIV testing services among young people in Nigeria

Nwaozuru

juliet

Ong

et al. 2019

Preprint

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Background Despite high HIV incidence rates among young people in Nigeria, less than 24% of this population have ever tested for HIV. These low HIV testing rates suggest that current testing services may not align with their testing preferences. To address this gap, the objective of this study was to assess preferences for HIV testing options among young people in Nigeria.Methods We conducted a cross-sectional study using survey to assess preferences for HIV testing options among 113 youth aged 14-24 years residing in Nigeria. The survey included a series of hypothetical HIV testing options, comprised of six characteristics centered around HIV testing service (i.e. location of testing, test administrator, mode of pre-test, mode of post-test counseling, type of HIV test, and cost of HIV test). For each characteristic, participants were asked to select one of the options that they prefer or indicate none of the above. A descriptive analysis of the preferences made by participants was conducted, summarizing proportions of participants who selected different options for HIV testing.Results The mean age of study participants was 19.5 years old (SD=2.7). Most youth (73, 64.6%) had at least a secondary school degree. There was pronounced heterogeneity in HIV testing preferences among young people. Although most youth preferred free HIV testing, 14 (16.7%) reported preferring paying a small amount compared to free testing. More youth preferred blood-based HIV self-testing 39(48.8%) compared to facility-based HIV testing and oral HIV self-testing.Conclusions Our finding suggest that young people have a range of HIV testing preferences in Nigeria. This suggests that a “one-size-fits-all” approach to delivering services to youth may be challenging in this context. HIV testing services can be optimized to reach young people if a variety options are provided to meet their unique preferences.

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Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

Cited by 23 publications

References 34 publications

High rates of retention and viral suppression in the scale‐up of antiretroviral therapy adherence clubs in Cape Town, South Africa

High rates of retention and viral suppression in the scale‐up of antiretroviral therapy adherence clubs in Cape Town, South Africa

Loss to follow‐up among children and adolescents growing up with HIV infection: age really matters

Preferences for HIV testing services among young people in Nigeria

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