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. 2016 Sep;59(3):298-304.
doi: 10.1016/j.jadohealth.2016.05.002. Epub 2016 Jun 18.

Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

Aimalohi A Ahonkhai  1 , Bolanle Banigbe  2 , Juliet Adeola  2 , Abdulkabir B Adegoke  3 , Susan Regan  4 , Ingrid V Bassett  5 , Ifeoma Idigbe  6 , Elena Losina  7 , Prosper Okonkwo  8 , Kenneth A Freedberg  9
Affiliations

Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

Aimalohi A Ahonkhai et al. J Adolesc Health. 2016 Sep.

Abstract

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 antiretroviral 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/μL in AYA and 204/μL 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.

Keywords: ART; Adolescents; HIV; Inconsistent care; Older adults; Resource-limited setting; Retention; Viremia; Young adults.

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Conflict of interest statement

All named authors declare that they do not have any conflict of interest either real or perceived.

Figures

Figure 1
Figure 1. Schematic of Adolescents and Young Adults Included in Study Cohort Assessing Risk of Inconsistent Care and Rates of Viremia in First Year After ART Initiation
Entire cohort (in care* and inconsistent care patients+) used to determine risk of inconsistent care in the first year on ART Subset of patients in care* used to determine rates of viremia in the first year on ART
Figure 2
Figure 2. Patterns of Care Use in a cohort of HIV-infected Nigerian adolescents and young adults compared to older adults
UCI: Unplanned care interruption
See this image and copyright information in PMC

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