High attrition before and after ART initiation among youth (15-24 years of age) enrolled in HIV care.
High attrition before and after ART initiation among youth (15-24 years of age) enrolled in HIV care.
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DOI：
10.1097/qad.0000000000000054
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发表时间：
2014-02-20
期刊：
影响因子：
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通讯作者：
Elul B
中科院分区：
文献类型：
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作者：
Lamb MR;Fayorsey R;Nuwagaba-Biribonwoha H;Viola V;Mutabazi V;Alwar T;Casalini C;Elul B
比较接受 HIV 护理的青少年（15-24 岁）和其他患者在 ART 治疗前和治疗后的流失情况，并调查与青少年流失相关的因素。队列研究利用了肯尼亚、莫桑比克、坦桑尼亚和卢旺达 160 个艾滋病毒诊所定期收集的患者数据。包括 2010 年 1 月 1 日至 2010 年 9 月期间参加艾滋病毒护理的年满 10 岁的患者。使用多变量竞争风险（ART 前）和传统（ART 后）Cox 比例风险方法（考虑临床内相关性）对青少年和其他患者之间的自然减员（入组或开始 ART 后 1 年失访或死亡）进行比较。在青年人中，与流失相关的患者层面和诊所层面的因素也进行了类似的评估。共有 312 335 名 10 岁以上患者参加了艾滋病毒护理； 147 936 人（47%）开始了 ART，其中 17% 参加护理，10% 开始 ART 是年轻人。与其他年龄组相比，青少年在接受 ART 治疗前后的流失率要高得多。在青少年中，非怀孕女性的 ART 前流失率低于男性 [细分风险比 = 0.90，95% 置信区间 (CI)：0.86–0.94]，而怀孕 [调整后风险比 (AHR) = 0.85，95% CI：0.74–0.97] 和非怀孕女性 (AHR = 0.79，95% CI：0.79，95% CI： 0.73–0.86) 女性青年在接受 ART 后的流失率低于男性。接受 ART 治疗后，前往提供性健康和生殖健康服务（包括安全套）的青少年诊所（AHR = 0.47，95% CI：0.32–0.70）和提供青少年支持小组的诊所（AHR = 0.73，95% CI：0.52–1.0）的流失率显着降低。与年轻的青少年和老年人相比，青少年在接受 ART 之前和之后的流失率要高得多。青少年友好型服务与减少青少年流失有关，特别是在开始抗逆转录病毒疗法之后。
To compare pre and post-ART attrition between youth (15–24 years) and other patients in HIV care, and to investigate factors associated with attrition among youth. Cohort study utilizing routinely collected patient-level data from 160 HIV clinics in Kenya, Mozambique, Tanzania, and Rwanda. Patients at least 10 years of age enrolling in HIV care between 01/05 and 09/10 were included. Attrition (loss to follow-up or death 1 year after enrollment or ART initiation) was compared between youth and other patients using multivariate competing risk (pre-ART) and traditional (post-ART) Cox proportional hazards methods accounting for within-clinic correlation. Among youth, patient-level and clinic-level factors associated with attrition were similarly assessed. A total of 312 335 patients at least 10 years of age enrolled in HIV care; 147 936(47%) initiated ART, 17% enrolling in care and 10% initiating ART were youth. Attrition before and after ART initiation was substantially higher among youth compared with other age groups. Among youth, nonpregnant women experienced lower pre-ART attrition than men [sub-division hazard ratio=0.90, 95% confidence interval (CI): 0.86–0.94], while both pregnant [adjusted hazard ratio (AHR) = 0.85, 95% CI: 0.74–0.97] and nonpregnant (AHR = 0.79, 95% CI: 0.73–0.86) female youth experienced lower post-ART attrition than men. Youth attending clinics providing sexual and reproductive health services including condoms (AHR = 0.47, 95% CI: 0.32–0.70) and clinics offering adolescent support groups (AHR = 0.73, 95% CI: 0.52–1.0) experienced significantly lower attrition after ART initiation. Youth experienced substantially higher attrition before and after ART initiation compared with younger adolescents and older adults. Adolescent-friendly services were associated with reduced attrition among youth, particularly after ART initiation.