Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013
Auld, A.F.; Agolory, S.G.; Shiraishi, R.W.; Wabwire-Mangen, F.; Kwesigabo, G.; Mulenga, M.; Hachizovu, S.; Asadu, E.; Tuho, M.Zanga.; Ettiegne-Traore, V.; Mbofana, F.; Okello, V.; Azih, C.; Denison, J.A.; Tsui, S.; Koole, O.; Kamiru, H.; Nuwagaba-Biribonwoha, H.; Alfredo, C.; Jobarteh, K.; Odafe, S.; Onotu, D.; Ekra, K.A.; Kouakou, J.S.; Ehrenkranz, P.; Bicego, G.; Torpey, K.; Mukadi, Y.Diul.; van Praag, E.; Menten, J.; Mastro, T.; Dukes Hamilton, C.; Swaminathan, M.; Dokubo, E.Kainne.; Baughman
MMWR. Morbidity and mortality weekly report 63(47): 1097-1103
2014
ISSN/ISBN: 1545-861X PMID: 25426651 Document Number: 578478
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.