Loss to follow-up among children and adolescents growing up with HIV infection: age really matters.
Katharina Kranzer, John Bradley, Joseph Musaazi, Mary Nyathi, Hilary Gunguwo, Wedu Ndebele, Mark Dixon, Mbongeni Ndhlovu, Andrea Rehman, Palwasha Khan, Florian Vogt, Tsitsi Apollo, Rashida Abbas Ferrand
Author Information
Katharina Kranzer: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
John Bradley: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Joseph Musaazi: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Mary Nyathi: Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
Hilary Gunguwo: Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
Wedu Ndebele: Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
Mark Dixon: Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
Mbongeni Ndhlovu: Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
Andrea Rehman: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Palwasha Khan: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Florian Vogt: Institute of Tropical Medicine, Antwerp, Belgium.
Tsitsi Apollo: AIDS and TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe.
Rashida Abbas Ferrand: Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
INTRODUCTION: Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from childhood through adolescence. METHODS: Individuals aged 5-19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5-9 (children), 10-14 (young adolescents) and 15-19 (older adolescents). The effect of age at ART initiation, current age (using a time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression. RESULTS: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5-9, 10-14 and 15-19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94-2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05-3.07). In older adolescents, the LTFU rate among those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups. CONCLUSIONS: Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.
