Adolescents living with HIV are at higher risk of death and loss to follow up from care: Analysis of cohort data from eight health facilities in Ethiopia


Autoři: Degu Jerene aff001;  Workeabeba Abebe aff002;  Kefyalew Taye aff003;  Andrea Ruff aff004;  Inger Hallstrom aff005
Působiště autorů: KNCV Tuberculosis Foundation, The Hague, The Netherlands aff001;  Addis Ababa University, Department of Pediatrics and Child Health, Addis Ababa, Ethiopia aff002;  Hawassa University, Department of Pediatrics and Child Health, Hawassa, Ethiopia aff003;  Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America aff004;  Lund University, Faculty of Medicine, Department of Health Sciences, Lund, Sweden aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223655

Souhrn

Background

There are limited data on the treatment outcomes of adolescents living with HIV. Our objective was to compare mortality and loss to follow up (LTFU) rates between adolescent and younger age groups at enrollment in care.

Methods

This was a retrospective cohort study carried out in eight health facilities in two regions of Ethiopia. Adolescents (age 10–14 and 15–19 year) and children (age 0–9 year) enrolled in chronic HIV care between 2005 and 2013 constituted the study population. We reviewed the individual patient charts between March and June 2014 and updated the data on the status of each patient through December 2015. We used death and loss-to-follow up as primary endpoints and used the Cox-regression analysis where age, categorized as adolescent versus child, was the main predictor variable.

Results

Of 2058 participants studied, 52.1% were adolescents. The cohort contributed 2422 person-years of observation (PYO) during the pre-ART follow-up, whereas 1531 patients put on ART contributed 5984 PYO. Of those put on ART, 209 (13.7%) LTFU and 92 (6%) deaths were reported. Adolescents in age group 15–19 yr had the highest risk of LTFU [adjusted hazard ratio, aHR (95% CI) = 3.1 2.1, 5.0 ] followed by those in age group 10–14 yr (aHR = 1.5 [0.9, 2.3]) compared with children aged 0–9 yr. Mortality hazard was significantly higher among younger adolescents (aHR = 2.8 [1.4, 5.4]) and older adolescents (aHR = 2.3 [1.1, 4.9]) compared with children.

Conclusions

Adolescents are at higher risk of mortality and LTFU as compared to children ages 0–9. Younger adolescents and children had similar LTFU rates. Narrow age band disaggregated analysis can serve as useful guide for tailoring interventions to the specific needs of different age groups.

Klíčová slova:

Adolescents – Age groups – Cohort studies – Death rates – Ethiopia – HIV – HIV epidemiology – HIV infections


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