Journal
JOURNAL OF ADOLESCENT HEALTH
Volume 59, Issue 3, Pages 298-304Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jadohealth.2016.05.002
Keywords
Adolescents; HIV; Young adults; Older adults; Inconsistent care; Retention; Viremia; ART; Resource-limited setting
Funding
- National Institute of Allergy and Infectious Diseases of the National Institutes of Health [K23 AI106406, R01 AI058736-09S1, R01 MH090326, P30AI060354]
- Centers for Disease Control and Prevention [5U2GPS001058]
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Purpose: Interruptions in HIV care are a major cause of morbidity and mortality, particularly in resource-limited settings. We compared engagement in care and virologic outcomes between HIV-infected adolescents and young adults (AYA) and older adults (OA) one year after starting anti-retroviral therapy (ART) in Nigeria. Methods: We conducted a retrospective cohort study of AYA (15-24 years) and OA (>24 years) who initiated ART from 2009-2011. We used negative binomial regression to model the risk of inconsistent care and viremia (HIV RNA >1,000 copies/mL) among AYA and OA in the first year on ART. Regular care included monthly ART pickup and 3-monthly clinical visits. Patients with <= 3 months between consecutive visits were considered in care. Those with inconsistent care had >3 months between consecutive visits. Results: The cohort included 354 AYA and 2,140 OA. More AYA than OA were female (89% vs. 65%, p < .001). Median baseline CD4 was 252/mu L in AYA and 204/mu L in OA (p = .002). More AYA had inconsistent care than OA (55% vs. 47%, p = .001). Adjusting for sex, baseline CD4, and education, AYA had a greater risk of inconsistent care than OA (Relative Risk [RR]: 1.15, p = .008). Among those in care after one year on ART, viremia was more common in AYA than OA (40% vs. 26% p = .003, RR: 1.53, p = .002). Conclusions: In a Nigerian cohort, AYA were at increased risk for inconsistent HIV care. Of patients remaining in care, youth was the only independent predictor of viremia at 1 year. Youth-friendly models of HIV care are needed to optimize health outcomes. (C) 2016 Society for Adolescent Health and Medicine. All rights reserved.
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