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. 2017 Jul 17;20(1):21737.
doi: 10.7448/IAS.20.1.21737.

Loss to follow-up among children and adolescents growing up with HIV infection: age really matters

Katharina Kranzer  1   2 , John Bradley  1 , Joseph Musaazi  1   3 , Mary Nyathi  4 , Hilary Gunguwo  4   5 , Wedu Ndebele  4   5 , Mark Dixon  4   5 , Mbongeni Ndhlovu  4   5 , Andrea Rehman  1 , Palwasha Khan  1 , Florian Vogt  6 , Tsitsi Apollo  7   8 , Rashida Abbas Ferrand  9   10
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Loss to follow-up among children and adolescents growing up with HIV infection: age really matters

Katharina Kranzer et al. J Int AIDS Soc. .

Abstract

Introduction: Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from childhood through adolescence.

Methods: Individuals aged 5-19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5-9 (children), 10-14 (young adolescents) and 15-19 (older adolescents). The effect of age at ART initiation, current age (using a time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression.

Results: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5-9, 10-14 and 15-19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94-2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05-3.07). In older adolescents, the LTFU rate among those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups.

Conclusions: Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.

Keywords: Africa; HIV; adolescent; lost-to-follow-up; transition.

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Conflict of interest statement

The authors have no competing interests.

References

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