Loss to follow-up among youth accessing outpatient HIV care and treatment services in Kisumu, Kenya
Loss to follow-up among youth accessing outpatient HIV care and treatment services in Kisumu, Kenya
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DOI：
10.1080/09540121.2015.1110234
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发表时间：
2016-04-02
影响因子：
1.7
通讯作者：
Cohen, C. R.
中科院分区：
文献类型：
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作者：
Ojwang', V. O.;Penner, J.;Cohen, C. R.
青年人特别容易感染艾滋病毒，然而，向他们提供艾滋病毒预防干预措施，让感染者参与并留住他们接受护理和治疗，仍然是一项挑战。我们试图确定失访（LTFU）的发生率，并探讨与肯尼亚基苏穆15-21岁艾滋病毒阳性青年门诊护理和治疗诊所的LTFU相关的社会人口统计学和临床特征。2007年7月至2010年9月期间，两个不同的艾滋病毒护理和治疗诊所招收了青年人，一个是专门针对青年的，另一个是面向家庭的。如果一个人离开艾滋病毒治疗诊所超过4个月，无论其抗逆转录病毒治疗状态如何，都被定义为LTFU。计算LTFU的发生率，并使用考克斯回归分析来确定与LTFU相关的因素。共入组924名青年（79%为女性），中位年龄为20岁（IQR 18-21）。超过一半（529例（57%））被记录为LTFU，其中139例（26%）在入组后立即为LTFU。LTFU的总体发生率为52.9/100人-年（p-y）。与LTFU相关的因素是研究期间的妊娠（粗HR 0.68，95% CI 0.53-0.89）; CD 4细胞计数>350（校正风险比（AHR）0.59，95% CI 0.39-0.90）;未接受抗逆转录病毒治疗（AHR 4.0，95% CI 2.70-5.88）;未披露HIV感染状态（AHR 1.43，95% CI 1.10-1.89）。入组临床、年龄、婚姻状况、就业状况、WHO临床疾病分期和受教育程度与LTFU无关。干预措施，以确定和登记到照顾青年，支持披露，并启动ART早期可能会提高青年的保留，需要进一步调查。还需要进一步的研究来探索艾滋病毒感染青年护理中LTFU的原因以及这些患者的真实结果。
Youth are particularly vulnerable to acquiring HIV, yet reaching them with HIV prevention interventions and engaging and retaining those infected in care and treatment remains a challenge. We sought to determine the incidence rate of loss to follow-up (LTFU) and explore socio-demographic and clinical characteristics associated with LTFU among HIV-positive youth aged 15-21 years accessing outpatient care and treatment clinics in Kisumu, Kenya. Between July 2007 and September 2010, youth were enrolled into two different HIV care and treatment clinics, one youth specific and the other family oriented. An individual was defined as LTFU when absent from the HIV treatment clinic for >= 4months regardless of their antiretroviral treatment status. The incidence rate of LTFU was calculated and Cox regression analysis used to identify factors associated with LTFU. A total of 924 youth (79% female) were enrolled, with a median age of 20 years (IQR 18-21). Over half, (529 (57%)), were documented as LTFU, of whom 139 (26%) were LTFU immediately after enrolment. The overall incidence rate of LTFU was 52.9 per 100 person-years (p-y). Factors associated with LTFU were pregnancy during the study period (crude HR 0.68, 95% CI 0.53-0.89); CD4 cell count >350 (adjusted hazard ratios (AHR) 0.59, 95% CI 0.39-0.90); not being on antiretroviral therapy (AHR 4.0, 95% CI 2.70-5.88); and non-disclosure of HIV infection status (AHR 1.43, 95% CI 1.10-1.89). The clinic of enrolment, age, marital status, employment status, WHO clinical disease stage and education level were not associated with LTFU. Interventions to identify and enrol youth into care earlier, support disclosure, and initiate ART earlier may improve retention of youth and need further investigation. Further research is also needed to explore the reasons for LTFU from care among HIV-infected youth and the true outcomes of these patients.