Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
J Acquir Immune Defic Syndr. 2018 Oct 1;79(2):164-172. doi: 10.1097/QAI.0000000000001796.
The data needed to understand the characteristics and outcomes, over time, of adolescents enrolling in HIV care in East Africa are limited.
Six HIV care programs in Kenya, Tanzania, and Uganda.
This retrospective cohort study included individuals enrolling in HIV care as younger adolescents (10-14 years) and older adolescents (15-19 years) from 2001-2014. Descriptive statistics were used to compare groups at enrollment and antiretroviral therapy (ART) initiation over time. The proportion of adolescents was compared with the total number of individuals aged 10 years and older enrolling over time. Competing-risk analysis was used to estimate 12-month attrition after enrollment/pre-ART initiation; post-ART attrition was estimated by Kaplan-Meier method.
A total of 6344 adolescents enrolled between 2001 and 2014. The proportion of adolescents enrolling among all individuals increased from 2.5% (2001-2004) to 3.9% (2013-2014, P < 0.0001). At enrollment, median CD4 counts in 2001-2004 compared with 2013-2014 increased for younger (188 vs. 379 cells/mm, P < 0.0001) and older (225 vs. 427 cells/mm, P < 0.0001) adolescents. At ART initiation, CD4 counts increased for younger (140 vs. 233 cells/mm, P < 0.0001) and older (64 vs. 323 cells/mm, P < 0.0001) adolescents. Twelve-month attrition also increased for all adolescents both after enrollment/pre-ART initiation (4.7% vs. 12.0%, P < 0.001) and post-ART initiation (18.7% vs. 31.2%, P < 0.001).
Expanding HIV services and ART coverage was likely associated with earlier adolescent enrollment and ART initiation but also with higher attrition rates before and after ART initiation. Interventions are needed to promote retention in care among adolescents.
在东非，了解青少年在 HIV 护理中随时间变化的特征和结局所需的数据有限。
肯尼亚、坦桑尼亚和乌干达的六个 HIV 护理项目。
本回顾性队列研究纳入了 2001 年至 2014 年间作为青少年（10-14 岁）和大龄青少年（15-19 岁）首次登记接受 HIV 护理的个体。采用描述性统计比较随时间变化的登记和抗逆转录病毒治疗（ART）开始时的两组。将青少年的比例与随时间登记的 10 岁及以上所有个体的总数进行比较。使用竞争风险分析估计登记/ART 启动前 12 个月的流失率；采用 Kaplan-Meier 方法估计 ART 启动后的流失率。
2001 年至 2014 年间共有 6344 名青少年登记。所有个体中青少年登记的比例从 2001-2004 年的 2.5%增加到 2013-2014 年的 3.9%（P<0.0001）。登记时，2001-2004 年与 2013-2014 年相比，年轻（188 与 379 个细胞/mm，P<0.0001）和大龄（225 与 427 个细胞/mm，P<0.0001）青少年的 CD4 计数中位数增加。在开始 ART 时，年轻（140 与 233 个细胞/mm，P<0.0001）和大龄（64 与 323 个细胞/mm，P<0.0001）青少年的 CD4 计数增加。所有青少年在登记/ART 启动前（4.7%比 12.0%，P<0.001）和启动后（18.7%比 31.2%，P<0.001）的 12 个月内的流失率也有所增加。
扩大 HIV 服务和 ART 覆盖率可能与青少年更早登记和更早开始 ART 治疗有关，但也与 ART 启动前后的更高流失率有关。需要采取干预措施，促进青少年在护理中的保留。
