Matyanga C M J, Takarinda K C, Owiti P, Mutasa-Apollo T, Mugurungi O, Buruwe L, Reid A J
Pharmaceutical Technology Department, Harare Institute of Technology, Harare, Zimbabwe.
AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe ; International Union Against Tuberculosis and Lung Disease, Paris, France.
Public Health Action. 2016 Jun 21;6(2):97-104. doi: 10.5588/pha.15.0077.
A non-governmental organisation-supported clinic offering health services including antiretroviral therapy (ART).
To compare ART retention between younger (age 10-14 years) vs. older (age 15-19 years) adolescents and younger (age 20-29 years) vs. older (age ⩾30 years) adults and determine adolescent- and adult-specific attrition-associated factors among those initiated on ART between 2010 and 2011.
Retrospective cohort study.
Of 110 (7%) adolescents and 1484 (93%) adults included in the study, no differences in retention were observed between younger vs. older adolescents at 6, 12 and 24 months. More younger adolescents were initiated with body mass index <16 kg/m(2) compared with older adolescents (64% vs. 47%; P = 0.04). There were more females (74% vs. 52%, P < 0.001) and fewer patients initiating ART with CD4 count ⩽350 cells/mm(3) (77% vs. 81%, P = 0.007) among younger vs. older adults. Younger adults demonstrated more attrition than older adults at all time-points. No attrition risk factors were observed among adolescents. Attrition-associated factors among adults included being younger, having a lower CD4 count and advanced human immunodeficiency virus disease at initiation, and initiation on a stavudine-based regimen.
Younger adults demonstrated greater attrition and may require more attention. We were unable to demonstrate differences in attrition among younger vs. older adolescents. Loss to follow-up was the main reason for attrition across all age groups. Overall, earlier presentation for ART care appears important for improved ART retention among adults.
一家由非政府组织支持的诊所提供包括抗逆转录病毒疗法（ART）在内的健康服务。
比较年龄较小（10 - 14岁）与年龄较大（15 - 19岁）青少年以及年龄较小（20 - 29岁）与年龄较大（≥30岁）成年人之间的ART治疗留存率，并确定2010年至2011年开始接受ART治疗的青少年和成年人中与治疗中断相关的特定因素。
回顾性队列研究。
在纳入研究的110名（7%）青少年和1484名（93%）成年人中，年龄较小与年龄较大的青少年在6、12和24个月时的留存率没有差异。与年龄较大的青少年相比，更多年龄较小的青少年开始治疗时体重指数<16 kg/m²（64%对47%；P = 0.04）。年龄较小的成年人中女性更多（74%对52%，P < 0.001），开始接受ART治疗时CD4细胞计数≤350个细胞/mm³的患者更少（77%对81%，P = 0.007）。在所有时间点，年龄较小的成年人比年龄较大的成年人治疗中断更多。在青少年中未观察到治疗中断风险因素。成年人中与治疗中断相关的因素包括年龄较小、开始治疗时CD4细胞计数较低、患有晚期人类免疫缺陷病毒疾病以及开始使用基于司他夫定的治疗方案。
年龄较小的成年人治疗中断更多，可能需要更多关注。我们未能证明年龄较小与年龄较大的青少年在治疗中断方面存在差异。失访是所有年龄组治疗中断的主要原因。总体而言，更早接受ART治疗护理对于提高成年人的ART留存率似乎很重要。
