Médecins Sans Frontières, Cape Town, South Africa.
Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
J Int AIDS Soc. 2022 Jan;25(1):e25854. doi: 10.1002/jia2.25854.
Youth living with HIV (YLWH) are less likely to initiate antiretroviral therapy (ART) and remain in care than older adults. It is important to identify effective strategies to address the needs of this growing population and prevent attrition from HIV care. Since 2008, two clinics have offered youth-targeted services exclusively to youth aged 12-25 in Khayelitsha, a high HIV-prevalence, low-income area in South Africa. We compared ART attrition among youth in these two clinics to youth in regular clinics in the same area.
We conducted a propensity score matched cohort study of individuals aged 12-25 years initiating ART at eight primary care clinics in Khayelitsha between 1 January 2008 and 1 April 2018. We compared attrition, defined as death or loss to follow-up, between those attending two youth clinics and those attending general primary healthcare clinics, using Cox proportional hazards regression. Follow-up time began at ART initiation and ended at attrition, clinic transfer or dataset closure. We conducted sub-analyses of patients attending adherence clubs.
The distribution of age, sex and CD4 count at ART initiation was similar across Youth Clinic A (N = 1383), Youth Clinic B (N = 1299) and general clinics (N = 3056). Youth at youth clinics were more likely than those at general clinics to have initiated ART before August 2011 (Youth Clinic A: 16%, Youth Clinic B: 23% and general clinics: 11%). Youth clinics were protective against attrition: HR 0.81 (95% CI: 0.71-0.92) for Youth Clinic A and 0.85 (0.74-0.98) for Youth Clinic B, compared to general clinics. Youth Clinic A club patients had lower attrition after joining an adherence club than general clinic patients in adherence clubs (crude HR: 0.56, 95% CI: 0.32-0.96; adjusted HR: 0.48, 95% CI: 0.28-0.85), while Youth Clinic B showed no effect (crude HR: 0.83, 95% CI: 0.48-1.45; adjusted HR: 1.07, 95% CI: 0.60-1.90).
YLWH were more likely to be retained in ART care in two different youth-targeted clinics compared to general clinics in the same area. Our findings suggest that multiple approaches to making clinics more youth-friendly can contribute to improving retention in this important group.
与成年人相比，感染艾滋病毒的青年（YLWH）启动抗逆转录病毒疗法（ART）并留在护理中不太可能。重要的是要确定有效的策略来满足这一不断增长的人群的需求，并防止他们从艾滋病毒护理中流失。自 2008 年以来，两家诊所专门为南非高艾滋病毒流行率、低收入地区的 Khayelitsha 12-25 岁的青年提供了以青年为目标的服务。我们比较了这两家诊所的青年与同一地区普通诊所的青年之间的 ART 流失情况。
我们对 2008 年 1 月 1 日至 2018 年 4 月 1 日期间在 Khayelitsha 的 8 个初级保健诊所开始接受 ART 的 12-25 岁个体进行了倾向评分匹配队列研究。我们使用 Cox 比例风险回归比较了在两个青年诊所就诊的青年和在普通初级保健诊所就诊的青年之间的流失情况，定义为死亡或失访。随访时间从开始接受 ART 开始，到流失、转诊所或数据集关闭结束。我们对参加遵医嘱俱乐部的患者进行了亚分析。
在青年诊所 A（N = 1383）、青年诊所 B（N = 1299）和普通诊所（N = 3056）中，年龄、性别和 CD4 计数在开始接受 ART 时的分布相似。与普通诊所相比，青年诊所的青年更有可能在 2011 年 8 月之前开始接受 ART（青年诊所 A：16%，青年诊所 B：23%和普通诊所：11%）。青年诊所具有保护作用，可降低流失率：与普通诊所相比，青年诊所 A 的 HR 为 0.81（95%CI：0.71-0.92），青年诊所 B 的 HR 为 0.85（0.74-0.98）。与普通诊所相比，青年诊所 A 的遵医嘱俱乐部患者在加入遵医嘱俱乐部后流失率较低（未经调整的 HR：0.56，95%CI：0.32-0.96；调整后的 HR：0.48，95%CI：0.28-0.85），而青年诊所 B 则没有效果（未经调整的 HR：0.83，95%CI：0.48-1.45；调整后的 HR：1.07，95%CI：0.60-1.90）。
与同一地区的普通诊所相比，YLWH 更有可能在两个不同的青年为目标的诊所中保留在 ART 护理中。我们的研究结果表明，采取多种方法使诊所更适合青年，可以有助于改善这一重要群体的保留率。
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