Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya

Abstract

Background The number of youth and adolescents (10–24 years) with HIV infection has increased substantially presenting unique challenges to effective health service delivery. Methods We examined routinely collected patient-level data for antiretroviral treatment (ART)-naive HIV-infected patients, aged 10–24 years, enrolled in care during 2006–2011 at 109 ICAP-supported health facilities in three provinces in Kenya. Loss to follow-up (LTF) was defined as having no clinic visit for 12 months prior to ART initiation (pre-ART) and 6 months for ART patients. Competing risk and Kaplan–Meier estimators were used to calculate LTF and death rates. Sub-distributional and Cox proportional-hazards models were used to identify potential predictors of death and LTF. Results Overall 22 832 patients were enrolled in care at 10–24 years of age, 69.5% were aged 20–24 years, and 82% were female. Median CD4+ cell count was 332 cells/μl (interquartile range 153–561); 70.8% were WHO stage I/II. Young adolescents (10–14 years) had more advanced WHO stage and lower median CD4+ cell count compared to youth (15–24 years) at enrollment (284 vs. 340 cells/μl; P <0.0001). Cumulative incidence of LTF and death at 24 months for pre-ART patients was 46.1% [95% confidence interval (CI) 45.4–46.8%) and 2.1% (95% CI 1.9–2.3%), respectively. For those on ART, 32.2% (95% CI 31.1–33.3%) were LTF and 3.9% (95% CI 1.7–2.3%) died within 24 months. LTF among pre-ART and ART patients was twice as high among youth compared to young adolescents. Conclusion LTF of young people with HIV in this Kenyan cohort was high and notably greater among youth compared to young adolescents. Novel strategies targeting these populations are urgently needed to improve retention.

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

“…One study in Kenya reported 44% pre-ART attrition among adolescents, which compares to 51% in our study [13]. Among patients with poor outcomes at 12 months, 95% pre-clinic and 83% post-clinic were pre-ART patients.…”

“…We also present data on linkage from HIV testing to enrolment in HIV care. Few studies are able to capture linkage from HIV testing to enrolment in care because longitudinal data are often missing at this step [11,13,38]. Our results show a high percentage of adolescents link to care after HIV testing, 86% in our study linked compared to 62 and 63% in two studies in similar settings [39,40].…”

“…This study shows that the highest adolescent attrition occurs during the pre-ART period. Finally, while the majority of participants of HIV-positive adolescent cohort studies are also female [11,13,28,41–43], our cohorts’ age is older (aged 16–19) and unique in that HIV transmission is likely via horizontal transmission and likely heterosexual transmission, not perinatal transmission. Studies in resource-poor settings often follow vertically infected children transitioning to adolescent and adult care [17,44].…”

HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub‐Saharan African countries

“…Moreover, facilities reported insufficient protocols for determining and managing both non‐adherence and LTFU, as well as limited use of counselling tools to inform their interventions. This is problematic as research indicates that adolescents and young people are at high risk of LTFU, especially those aged 15–19 years [7,8,19,20]. …”

Experiences along the HIV care continuum: perspectives of Kenyan adolescents and caregivers

“…For example, adolescent HIV testing in Kenya is well below the World Health Organization 90% target at 35% and 27% among females and males aged 15–19, respectively (UNICEF, 2016). Additionally, a growing number of studies in southern and eastern sub-Saharan countries have found that youth ages 15–24 years are less likely to enrol in care after HIV diagnosis and more likely to be lost to care after enrolment compared to either older or younger groups (Auld et al, 2014; Bygrave et al, 2012; Evans et al, 2013; Genberg et al, 2015; Hatcher et al, 2012; Koech et al, 2014; Lamb et al, 2014; Naik et al, 2015). They are also less likely than adults to adhere to ART after initiation and subsequently experience shorter time to viral rebound and lower rates of virological suppression and immunological recovery (Nachega et al, 2009).…”