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African adolescents less likely to follow up with ART vs. adults
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Data from a retrospective study conducted in seven African countries with a predominantly young female cohort indicated adolescents were less likely to follow up with ART compared with older adults.
Andrew F. Auld, MBChB, from the Division of Global HIV/AIDS at the CDC, and colleagues assessed ART enrollment and outcome data for 16,421 patients aged 15 years and older at ART enrollment who initiated therapy during 2004 to 2012. Participants aged 15 to 24 years were predominantly female, pregnant and unmarried.
Despite an increase in ART since 2005, as well as decreased HIV-related deaths and lower HIV incidence globally, annual HIV-related deaths among adolescents have increased approximately 50%, according to Auld and colleagues.
In 2012, approximately 40% of all daily new HIV infections occurred among patients aged 15 to 24 years.
Researchers considered patients who did not attend an ART facility for a medication refill, laboratory visit or clinician visit in 90 days a “loss to follow-up.”
Rates of loss to follow-up were highest among patients aged 15 to 24 years in all seven countries and reached statistical significance in Côte d’Ivoire (P=.005), Mozambique (P<.001) and Tanzania (P=.005).
After adjusting for demographic and clinical characteristics, loss to follow-up rates among patients aged 15 to 24 years were 1.66 to 2.45 times higher compared with patients aged 50 years and older in Côte d’Ivoire, Mozambique and Tanzania.
In Swaziland and Uganda, patients aged 50 years and older exhibited significantly higher rates of documented mortality compared with younger age groups. However, according to researchers, the study findings may be influenced by the uneven demographic of study participants.
“Available data suggest that this group of predominantly female adolescent and young adult ART enrollees represents a socially-vulnerable population,” Auld and colleagues wrote. “In African countries with generalized epidemics, being young, female and unemployed increases the risk for voluntary or coerced sexual contact with older, HIV-infected men.”
Stigma, lack of funds for transportation, child care responsibilities and migration for work may also be contributing factors to loss to follow-up from ART.
“Loss to follow-up from ART is associated with significant increases in mortality risk,” Auld and colleagues wrote. “Effective interventions to reduce loss to follow-up for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group.”
Disclosure: The researchers report no relevant financial disclosures.
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Auld AF. MMWR. 2014; 63(47):1097-1103.
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