Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART.
Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART.
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DOI：
10.1002/jia2.25178
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发表时间：
2018-09
影响因子：
6
通讯作者：
International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration
中科院分区：
文献类型：
--
作者：
Nuwagaba-Biribonwoha H;Kiragga AN;Yiannoutsos CT;Musick BS;Wools-Kaloustian KK;Ayaya S;Wolf H;Lugina E;Ssali J;Abrams EJ;Elul B;International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration
青春期和妊娠是抗逆转录病毒治疗（ART）期间失访（LTFU）的潜在危险因素。我们比较了开始 ART 后青少年和成人的 LTFU，以量化年龄、妊娠和部位因素对 LTFU 的影响。我们使用了 2000 年至 2014 年在隶属于国际艾滋病评估流行病学数据库 (IeDEA) 东非合作的 52 个医疗机构中开始接受 ART 的患者的常规临床数据，包括青少年（YA；10 至 14 岁）、老年青少年（OA；15 至 19 岁）和成人（≥20 岁）。我们对所有患者以及各个年龄组使用多变量 Cox 比例风险模型，估计了 LTFU 的累积发生率（95% 置信区间，CI）（开始 ART 后 ≥6 个月没有就诊），并确定了 LTFU 的患者和地点水平相关性。共有 138,387 名患者开始接受 ART，其中包括 2496 名 YA 患者、2955 名 OA 患者和 132,936 名成人。其中，55%、78% 和 66% 分别为女性，0.7% 的 YA、22.3% 的 OA 和 8.3% 的成年人在 ART 开始时怀孕。五年内LTFU的累积发生率在YA中为26.6%（24.6至28.6），在OA中为44.1%（41.8至46.3），在成人中为29.3%（29.1至29.6）。总体而言，与成人相比，LTFU 治疗 OA 的调整后风险比 aHR（95% CI）为 1.54（1.41 至 1.68），YA 为 0.77（0.69 至 0.86）。与男性相比，怀孕女性的 LTFU 风险较高，aHR 1.20（1.14 至 1.27），而非怀孕女性的 aHR 风险较低，为 0.90（0.88 至 0.93）。 OA 中的 LTFU 风险主要由怀孕和非怀孕女性驱动，与男性相比，aHR 分别为 2.42（1.98 至 2.95）和 1.51（1.27 至 1.80）。 LTFU 风险比因 IeDEA 计划而异。与总体较低 LTFU 风险相关的场所因素包括在三级诊所接受护理相对于初级保健诊所 aHR 0.61（0.56 至 0.67）、成人和青少年综合服务和食物配给供应 aHR 0.93（0.89 至 0.97）与提供食物配给的非综合诊所相比、患者支持小组 aHR 0.77（0.66 至 0.90）以及团体依从性咨询aHR 0.61（0.57 至 0.67）。与青少年和成人相比，年龄较大的青少年发生 LTFU 的风险更高。迫切需要采取干预措施来预防年龄较大的青少年的 LTFU，特别是对于女性和/或怀孕的青少年。
Adolescence and pregnancy are potential risk factors for loss to follow‐up (LTFU) while on antiretroviral therapy (ART). We compared adolescent and adult LTFU after ART initiation to quantify the impact of age, pregnancy, and site‐level factors on LTFU. We used routine clinical data for patients initiating ART as young adolescents (YA; 10 to 14 years), older adolescents (OA; 15 to 19 years) and adults (≥20 years) from 2000 to 2014 at 52 health facilities affiliated with the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa collaboration. We estimated cumulative incidence (95% confidence interval, CI) of LTFU (no clinic visit for ≥6 months after ART initiation) and identified patient and site‐level correlates of LTFU, using multivariable Cox proportional hazards models for all patients as well as individual age groups. A total of 138,387 patients initiated ART, including 2496 YA, 2955 OA and 132,936 adults. Of these, 55%, 78% and 66%, respectively, were female and 0.7% of YA, 22.3% of OA and 8.3% of adults were pregnant at ART initiation. Cumulative incidence of LTFU at five years was 26.6% (24.6 to 28.6) among YA, 44.1% (41.8 to 46.3) among OA and 29.3% (29.1 to 29.6) among adults. Overall, compared to adults, the adjusted hazard ratio, aHR, (95% CI) of LTFU for OA was 1.54 (1.41 to 1.68) and 0.77 (0.69 to 0.86) for YA. Compared to males, pregnant females had higher hazard of LTFU, aHR 1.20 (1.14 to 1.27), and nonpregnant women had lower hazard aHR 0.90 (0.88 to 0.93). LTFU hazard among the OA was primarily driven by both pregnant and nonpregnant females, aHR 2.42 (1.98 to 2.95) and 1.51 (1.27 to 1.80), respectively, compared to men. The LTFU hazard ratio varied by IeDEA program. Site‐level factors associated with overall lower LTFU hazard included receiving care in tertiary versus primary‐care clinics aHR 0.61 (0.56 to 0.67), integrated adult and adolescent services and food ration provision aHR 0.93 (0.89 to 0.97) versus nonintegrated clinics with food ration provision, having patient support groups aHR 0.77 (0.66 to 0.90) and group adherence counselling aHR 0.61 (0.57 to 0.67). Older adolescents experienced higher risk of LTFU compared to YA and adults. Interventions to prevent LTFU among older adolescents are critically needed, particularly for female and/or pregnant adolescents.
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DOI：
10.1097/qai.0000000000000771
发表时间：
2015-11-01
影响因子：
3.6
作者：
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通讯作者：
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影响因子：
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影响因子：
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DOI：
10.1080/09540120701244943
发表时间：
2007-01-01
影响因子：
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作者：
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影响因子：
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