Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART

the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration

Research output: Contribution to journalArticle

Abstract

Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Article numbere25178
JournalJournal of the International AIDS Society
Volume21
Issue number9
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Fingerprint

Pregnancy in Adolescence
Therapeutics
Acquired Immunodeficiency Syndrome
Epidemiology
Databases
Confidence Intervals
Food Services
Pregnancy
Eastern Africa
Self-Help Groups
Health Facilities
Incidence
Tertiary Healthcare
Ambulatory Care
Proportional Hazards Models
Counseling
Primary Health Care
Age Groups
Food

Keywords

  • adolescents
  • Africa
  • antiretroviral therapy (ART)
  • ART retention
  • HIV outcomes
  • pregnancy

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration (2018). Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART. Journal of the International AIDS Society, 21(9), [e25178]. https://doi.org/10.1002/jia2.25178

Adolescent pregnancy at antiretroviral therapy (ART) initiation : a critical barrier to retention on ART. / the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration.

In: Journal of the International AIDS Society, Vol. 21, No. 9, e25178, 01.09.2018.

Research output: Contribution to journalArticle

the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration 2018, 'Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART', Journal of the International AIDS Society, vol. 21, no. 9, e25178. https://doi.org/10.1002/jia2.25178
the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration. Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART. Journal of the International AIDS Society. 2018 Sep 1;21(9). e25178. https://doi.org/10.1002/jia2.25178
the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration. / Adolescent pregnancy at antiretroviral therapy (ART) initiation : a critical barrier to retention on ART. In: Journal of the International AIDS Society. 2018 ; Vol. 21, No. 9.
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abstract = "Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.",
keywords = "adolescents, Africa, antiretroviral therapy (ART), ART retention, HIV outcomes, pregnancy",
author = "{the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration} and Harriet Nuwagaba-Biribonwoha and Kiragga, {Agnes N.} and Constantin Yiannoutsos and Musick, {Beverly S.} and Kara Wools-Kaloustian and Samuel Ayaya and Hilary Wolf and Emmanuel Lugina and John Ssali and Abrams, {Elaine J.} and Batya Elul",
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TY - JOUR

T1 - Adolescent pregnancy at antiretroviral therapy (ART) initiation

T2 - a critical barrier to retention on ART

AU - the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa Collaboration

AU - Nuwagaba-Biribonwoha, Harriet

AU - Kiragga, Agnes N.

AU - Yiannoutsos, Constantin

AU - Musick, Beverly S.

AU - Wools-Kaloustian, Kara

AU - Ayaya, Samuel

AU - Wolf, Hilary

AU - Lugina, Emmanuel

AU - Ssali, John

AU - Abrams, Elaine J.

AU - Elul, Batya

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.

AB - Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.

KW - adolescents

KW - Africa

KW - antiretroviral therapy (ART)

KW - ART retention

KW - HIV outcomes

KW - pregnancy

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