Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program

Kawilapat, Suttipong; Salvadori, Nicolas; Ngo‐Giang‐Huong, Nicole; Decker, Luc; Kanjanavanit, Suparat; Puangsombat, Achara; Preedisripipat, Kanchana; Lertpienthum, Narong; Akarathum, Noppadon; Mekmullica, Jutarat; Srirompotong, Ussanee; Lallemant, Marc; Cœur, Sophie Le; Traisathit, Patrinee; Leroi, Charline; Jourdain, Gonzague

doi:10.1371/journal.pone.0222082

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…For example, a study conducted in India on the same population reported that age affected treatment outcomes such as LTFU [ 73 ], as did cohort data from the Asia-Pacific region, the Caribbean, and Central and South America [ 25 ]. However, at least one study conducted in Thailand [ 26 ] reported that LTFU was higher among younger ALHIV.…”

Section: Discussionmentioning

confidence: 99%

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The proportion of loss to follow-up from antiretroviral therapy (ART) and its association with age among adolescents living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

et al. 2022

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Background Human immunodeficiency virus (HIV) remains a global health threat, especially in developing countries. The successful scale-up of antiretroviral therapy (ART) programs to address this threat is hindered by a high proportion of patient loss to follow-up (LTFU). LTFU is associated with poor viral suppression and increased mortality. It is particularly acute among adolescents, who face unique adherence challenges. Although LTFU is a critical obstacle on the continuum of care for adolescents, few regional-level studies report the proportion of LTFU among adolescents receiving ART. Therefore, a systematic review and meta-analysis were conducted to estimate the pooled LTFU in ART programs among adolescents living with HIV in sub-Saharan Africa (SSA). Methods We searched five databases (PubMed, Embase (Elsevier), PsycINFO, CINAHL, and Scopus) for articles published between 2005 and 2020 and reference lists of included articles. The PRISMA guidelines for systematic reviews were followed. A standardised checklist to extract data was used. Descriptive summaries were presented using narrative tables and figures. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I2 test. Random effect models were used to estimate the pooled prevalence of LTFU among ALHIV. We used Stata version 16 statistical software for our analysis. Results Twenty-nine eligible studies (n = 285,564) were included. An estimated 15.07% (95% CI: 11.07, 19.07) of ALHIV were LTFU. Older adolescents (15–19 years old) were 43% (AOR = 0.57, 95% CI: 0.37, 0.87) more likely to be LTFU than younger (10–14 years old) adolescents. We find an insignificant relationship between gender and LTFU (AOR = 0.95, 95% CI: 0.87, 1.03). A subgroup analysis found that regional differences in the proportion of adolescent LTFU were not statistically significant. The trend analysis indicates an increasing proportion of adolescent LTFU over time. Conclusions and recommendations The proportion of LTFU among HIV-positive adolescents in SSA seems higher than those reported in other regions. Older adolescents in the region are at an increased risk for LTFU than younger adolescents. These findings may help policymakers develop appropriate strategies to retain ALHIV in ART services. Such strategies could include community ART distribution points, appointment spacing, adherence clubs, continuous free access to ART, and community-based adherence support.

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Section: Discussionmentioning

confidence: 99%

“…Cohort data from the Asia-Pacific, the Caribbean, and Central and South American regions [ 25 ] have found LTFU associated with gender, age, and rural settings. Data from Thailand [ 26 ] have indicated that age and malnutrition have a significant association with LTFU.…”

Section: Introductionmentioning

confidence: 99%

The proportion of loss to follow-up from antiretroviral therapy (ART) and its association with age among adolescents living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

et al. 2022

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“…Although, one study revealed people who were initiating ART at an older age were more likely to discontinue their treatment [34]. Also, according to some studies, adolescents and young adults were at higher risk of LTFU compared to both younger children under 10 and adults older than 45 [83]. In children and adolescents, growth retardation due to ART has been cited as one of the important reasons for discontinuation of treatment [83].…”

Section: Discussionmentioning

confidence: 99%

“…Also, according to some studies, adolescents and young adults were at higher risk of LTFU compared to both younger children under 10 and adults older than 45 [83]. In children and adolescents, growth retardation due to ART has been cited as one of the important reasons for discontinuation of treatment [83]. In one study in children under two years of age, the child's nutritional status and side effects of starting treatment, such as diarrhea, were cited as potential reasons for treatment discontinuation [42].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and reasons of loss to follow-up in HIV clinics: a systematic review of current evidence

SeyedAlinaghi¹,

Barzegary²,

Pashaei³

et al. 2022

HIV & AIDS Review

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“…Several factors influencing retention to treatment among CLHIV have been studied including but not limited to age ( 1 , 2 , 18 ), disease stage ( 1 , 19 ), nutritional status ( 18 , 20 ), and history of interrupted ART ( 21 ). However, most of these studies have been facility-based, lacking evidence of the role of community-based programs to support retention in HIV care and treatment services for PLHIV.…”

Section: Introductionmentioning

confidence: 99%

Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania

Charles¹,

Exavery²,

Ally³

et al. 2022

Front. Public Health

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Despite the global progress in response to HIV and AIDS, notable challenges remain for children, especially identification, linkage, and retention in HIV care and treatment services. To succeed in pediatric HIV programming requires the linkage and retention of the children in those services over time. This study assessed the level of retention to antiretroviral therapy (ART) and its associated factors among orphans and vulnerable children living with HIV (OVCLHIV) in Tanzania. Data were obtained from the USAID Kizazi Kipya project that collected pediatric ART data from October 2017 to October 2019 in 81 district councils of Tanzania. Community-based volunteers supported the linkage and retention of the OVCLHIV on ART. Analysis of on-ART status was conducted in a cohort of OVCLHIV aged 0–20 years enrolled in the project and monitored for 24 months. OVCLHIV who remained on ART until the end of the follow-up period were referred to as “retained,” otherwise, “not retained”. Multivariable analysis was conducted using logistic regression, adjusting for baseline characteristics. Of the 5,304 OVCLHIV analyzed, the mean age was 13.1 years, 51.5% were female, and 72.2% were living with female caregivers. Their overall rate of retention on ART over the 24 months was 86.7%. Multivariable analysis showed that as the higher frequency of home visit by the project staff increased, the likelihood of retention increased by 8% [adjusted odds ratio (aOR) = 1.08, 95% CI 1.06–1.11, p < 0.001]. Membership in people living with HIV (PLHIV) support groups was associated with a higher likelihood of retention compared to nonmembership (aOR = 3.31, 95% CI 2.60–4.21, p < 0.001). Children in larger family size were 22% less likely to sustain ART (aOR = 0.78, 95% CI 0.72–0.84, p < 0.001). Urban OVCLHIV were 18% less likely to remain on ART than their rural counterparts (aOR = 0.82, 95% CI 0.69–0.98, p = 0.030). Remaining on ART was 49% more likely for OVC in economically better-off households than those in destitute households (aOR = 1.49, 95% CI 1.22–1.81, p < 0.001). Male OVC were 17% less likely to be retained on ART than their female counterparts (aOR = 0.83, 95% CI 0.71–0.99, p = 0.033). Community-based OVC support resulted in a high pediatric retention rate over the 24 months of follow-up. While key enablers of retention were higher frequency of home visits by the project volunteer, participation in PLHIV support groups, and better economic status, large family sizes, urban place of residence, and male gender of the OVC were barriers. This study brings useful evidence to inform strategies for advancing retention of OVCLHIV on ART for their better health outcomes and overall wellbeing.

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Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program

Cited by 3 publications

References 24 publications

The proportion of loss to follow-up from antiretroviral therapy (ART) and its association with age among adolescents living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

The proportion of loss to follow-up from antiretroviral therapy (ART) and its association with age among adolescents living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

Prevalence and reasons of loss to follow-up in HIV clinics: a systematic review of current evidence

Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania

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