between 15 and 24 years are significantly more likely to drop out of HIV
care compared to individuals in other age groups, research published in the online
edition of AIDS shows. The research
was conducted in four sub-Saharan African countries and involved patients newly
entered HIV care or initiating antiretroviral therapy (ART) between 2005 and
2010. Patients in the 15- to 24-years age group were significantly more likely
to be lost to follow-up compared to both younger and older age groups.
provides important insights on program outcomes previously not sufficiently
described,” comment the authors. “In addition to confirming attrition 1 year
after starting ART…we found that youth were substantially more likely than
young adolescents and older adults to die or be lost to follow-up before initiating
of all HIV-positive people in sub-Saharan Africa are aged between 15 and 24
years (youth), and 40% of incident infections are in this age group. Previous research
has shown that there is a high attrition rate among young people in sub-Saharan Africa
in the first year after starting HIV therapy.
team of investigators wanted to see if this was also the case for young people newly
entering HIV care.
collected data from 160 HIV clinics in Kenya, Mozambique, Tanzania and Rwanda. Between
2005 and 2010, these clinics provided care to 312,335 patients who newly entered
care or who started treatment.
compared attrition rates (death or loss to follow-up) between youth and other
age groups (10 to 14 years; 25 to 54 years; 55 years and over) in the first year after
entry into HIV care pre-ART and in the first year after the initiation of HIV
therapy. The factors associated with loss to follow-up were also explored.
Young people account for
17% of patients entering care and 10% of patients starting HIV therapy.
Young people had higher
median CD4 cell counts when entering care compared to other age groups (383
cells/mm3 vs 348 cells/mm3 [10 to 14 years]; 251 cells/mm3
[25 to 54 years); 232 cells/mm3 [55 years and over]).
patients starting HIV therapy showed that patients aged between 15 and 24 years
had a median CD4 cell count of 184 cells/mm3, which was lower than
patients aged between 10 and 14 years (204 cells/mm3) but higher than
individuals in the older age groups (161 cells/mm3 and 169 cells/mm3,
a third (32%) of pre-ART patients had died or were lost to follow-up in the
first year after entering HIV care. The rate of attrition among young patients
The rate of
attrition in the first year after starting HIV therapy was 17% overall and 27%
among young people.
The vast majority
of cases of attrition, both before (98%) and after (87%) the initiation of ART,
among patients aged between 15 and 24 were due to loss to follow-up rather than
“Youth may be
becoming LTF [lost to follow-up] for reasons other than illness,” comment the
authors. “High levels of migration for work, and lack of belief in the benefits
of attending clinic and initiating ART among youth, particularly if healthy and
not yet eligible to initiate ART, are two possible explanations.”
Young people were between
50 and 100% more likely to die or drop out of HIV care before and after
treatment, compared to other age groups.
among young people pre-ART were significantly lower among pregnant women than in men. Among
young people starting therapy, both pregnant and non-pregnant women had a lower risk
of attrition compared to men.
The provision of
youth-friendly services reduced the risk of loss to follow-up after starting
Young people attending
clinics providing sexual and reproductive health services, including condom provision, had
a significantly lower risk of attrition (AHR = 0.47; 95% CI, 0.32-0.70), as did
15- to 24-year-olds attending clinics that offered adolescent support (AHR =
0.73; 95% CI, 0.52-1.0).
“We suggest that
youth-friendly interventions be implemented and evaluated for their
effectiveness in improving retention,” conclude the investigators.