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Clinical Trial
. 2019 Feb 5;14(2):e0210937.
doi: 10.1371/journal.pone.0210937. eCollection 2019.

HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town

Pancho Mulongeni  1   2 , Sabine Hermans  1   3 , Judy Caldwell  4 , Linda-Gail Bekker  1 , Robin Wood  1 , Richard Kaplan  1
Affiliations
Clinical Trial

HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town

Pancho Mulongeni et al. PLoS One. .

Abstract

TB remains a leading cause of mortality and morbidity in sub-Saharan Africa, due to the HIV epidemic. As TB treatment is lengthy, the completion of the full course of treatment may be especially challenging for young people. We therefore aimed to identify the extent of and reasons underlying loss to follow-up from TB treatment among young people in Cape Town. Accordingly, we reviewed the outcomes of young people treated for TB in Cape Town during 2009-2013, across three age groups: younger adolescents (10-14 years); older adolescents; (15-19 years) and young adults (20-24 years). We employed logistic regression analysis to identify risk factors for loss from TB care. 23,737 patients aged 10-24 were treated for drug sensitive TB over the study period. Of these, the HIV co-infection prevalence was 18.5% for younger adolescents, 12.9% for older adolescents and 33.1% for young adults. From age 16, HIV prevalence increased disproportionately among young women: by age 22, over 50% of women were TB/HIV co-infected compared to 14% of men. TB treatment success (cure plus completion) was 84.4%, while 1.7% of patients died, 9.5% were lost-to follow-up and 0.4% failed treatment. Being an older adolescent (aOR 1.75 [95% CI: 1.38-2.21]) or young adult (aOR: 1.96 [95% CI: 1.57-2.45]) increased the risk of loss-to-follow up, relative to being a younger adolescent. Further risk factors for loss from TB care were male gender (aOR: 1.33 [95% CI:1.20-1.46]), being a TB/HIV co-infected young person (aOR 1.74 [95% CI: 1.57-1.93]) and having had prior treatment for TB (aOR 3.17 [95% CI 2.87-3.51]). We identified risk factors for loss to follow-up and highlighted the need to focus on HIV prevention and retention in TB care among young people. TB care tailored to the needs of young people could improve patient retention, similar to improved outcomes reported by youth friendly HIV clinics.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Trends in case notification rates per 100 000 population by age group, in Cape Town.
Fig 2
Fig 2. Prevalence of TB/HIV co-infection, across age categories, for female adolescents and young women treated for TB in Cape Town during 2009–13.
Fig 3
Fig 3. Prevalence of TB/HIV co-infection, across age categories, for male adolescents and young men treated for TB in Cape Town during 2009–13.
Fig 4
Fig 4. Proportion of younger adolescents, older adolescents and young adults with TB/HIV coinfection on ART at start of TB treatment per calendar year.
Fig 5
Fig 5. Kaplan Meier survival curve for loss to follow-up among young people in TB care by age group.
See this image and copyright information in PMC

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