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Comparative Study
. 2019 Dec 15;82(5):431-438.
doi: 10.1097/QAI.0000000000002184.

Dual Analysis of Loss to Follow-up for Perinatally HIV-Infected Adolescents Receiving Combination Antiretroviral Therapy in Asia

Adam W Bartlett  1 , Pagakrong Lumbiganon  2 , Thahira A Jamal Mohamed  3 , Keswadee Lapphra  4 , Dina Muktiarti  5 , Quy Tuan Du  6 , Rawiwan Hansudewechakul  7 , Penh Sun Ly  8 , Khanh Huu Truong  6 , Lam Van Nguyen  9 , Thanyawee Puthanakit  10   11 , Tavitiya Sudjaritruk  12 , Kulkanya Chokephaibulkit  4 , Viet Chau Do  13 , Nagalingeswaran Kumarasamy  14 , Nik Khairulddin Nik Yusoff  15 , Nia Kurniati  5 , Moy Siew Fong  16 , Dewi Kumara Wati  17 , Revathy Nallusamy  18 , Annette H Sohn  19 , Azar Kariminia  1 ; TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific
Affiliations
Comparative Study

Dual Analysis of Loss to Follow-up for Perinatally HIV-Infected Adolescents Receiving Combination Antiretroviral Therapy in Asia

Adam W Bartlett et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Perinatally HIV-infected adolescents (PHIVA) are an expanding population vulnerable to loss to follow-up (LTFU). Understanding the epidemiology and factors for LTFU is complicated by varying LTFU definitions.

Setting: Asian regional cohort incorporating 16 pediatric HIV services across 6 countries.

Methods: Data from PHIVA (aged 10-19 years) who received combination antiretroviral therapy 2007-2016 were used to analyze LTFU through (1) an International epidemiology Databases to Evaluate AIDS (IeDEA) method that determined LTFU as >90 days late for an estimated next scheduled appointment without returning to care and (2) the absence of patient-level data for >365 days before the last data transfer from clinic sites. Descriptive analyses and competing-risk survival and regression analyses were used to evaluate LTFU epidemiology and associated factors when analyzed using each method.

Results: Of 3509 included PHIVA, 275 (7.8%) met IeDEA and 149 (4.3%) met 365-day absence LTFU criteria. Cumulative incidence of LTFU was 19.9% and 11.8% using IeDEA and 365-day absence criteria, respectively. Risk factors for LTFU across both criteria included the following: age at combination antiretroviral therapy initiation <5 years compared with age ≥5 years, rural clinic settings compared with urban clinic settings, and high viral loads compared with undetectable viral loads. Age 10-14 years compared with age 15-19 years was another risk factor identified using 365-day absence criteria but not IeDEA LTFU criteria.

Conclusions: Between 12% and 20% of PHIVA were determined LTFU with treatment fatigue and rural treatment settings consistent risk factors. Better tracking of adolescents is required to provide a definitive understanding of LTFU and optimize evidence-based models of care.

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Figures

Figure 1.
Figure 1.. Outcomes for study population using IeDEA and 365-day absence loss to follow-up criteria.
IeDEA = International epidemiology Databases to Evaluate AIDS. LTFU = loss to follow-up.
Figure 2.
Figure 2.. Cumulative incidence of loss to follow-up throughout adolescence for IeDEA and 365-day absence criteria.
IeDEA = International epidemiology Databases to Evaluate AIDS. LTFU = loss to follow-up.
See this image and copyright information in PMC

References

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