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J Adolesc Health. 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.

Author information

1
Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: aahonkhai@mgh.harvard.edu.
2
AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria.
3
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts.
4
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts.
5
Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts.
6
Nigerian Institute for Medical Research, Lagos, Nigeria.
7
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
8
Harvard Medical School, Boston, Massachusetts.
9
Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

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

PMID:
27329680
PMCID:
PMC5022362
DOI:
10.1016/j.jadohealth.2016.05.002
[Indexed for MEDLINE]
Free PMC Article

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