School of Public Health, University of the Western Cape, Cape Town, South Africa.
BMC Public Health. 2023 Mar 8;23(1):458. doi: 10.1186/s12889-023-15356-w.
BACKGROUND: Long-term engagement in HIV care is essential to achieving and maintaining viral suppression. Adolescents living with HIV (ALHIV) experience many barriers to remaining engaged in care and treatment programs. Higher attrition among adolescents compared to adults remains a huge concern due to unique psychosocial and health systems challenges adolescents face, and recently the COVID-19 pandemic effects. We report on determinants and rates of retention in care in adolescents aged 10-19 years enrolled on antiretroviral therapy (ART) in Windhoek, Namibia. METHODS: A retrospective cohort analysis of routine clinical data of 695 adolescents aged 10-19 years enrolled for ART at 13 Windhoek district public healthcare facilities, between January 2019 and December 2021 was conducted. Anonymized patient data were extracted from an electronic database and registers. Bivariate and Cox proportional hazards analysis were performed to determine factors associated with retention in care among ALHIV at 6, 12, 18, 24 and 36 months. Retention in care trends were also described using the Kaplan-Meier survival analysis. RESULTS: The retention in care rates at 6, 12, 18, 24 and 36 months were 97.7%, 94.1%, 92.4%, 90.2%, and 84.6%, respectively. Our study population had predominantly treatment-experienced adolescents, who initiated ART between birth and 9 years (73.5%), were on treatment for > 24 months (85.0%), and on first-line ART (93.1%). After controlling for confounders, the risk of dropping out of care was increased for older adolescents aged 15-19 years (aHR = 1.964, 95% CI 1.033-3.735); adolescents on switched ART regimens (Second line + Third line regimen) (aHR = 4.024, 95% CI 2.021-8.012); adolescents who initiated ART at 15-19 years (aHR = 2.179, 95%CI 1.100-4.316); and male adolescents receiving ART at a PHC clinic (aHR = 4.322, 1.332-14.024). Conversely, the risk of ALHIV dropping out of care decreased for adolescents whose TB screen results were negative (aHR = 0.215, 95% CI 0.095-0.489). CONCLUSION: Retention in care rates among ALHIV in Windhoek do not meet the UNAIDS revised target of 95%. Gender-specific interventions are needed to keep male and older adolescents motivated and engaged in long-term care, and to promote adherence amongst those adolescents who were initiated on ART in late adolescence (15-19 years).
背景：长期参与艾滋病毒护理对于实现和维持病毒抑制至关重要。感染艾滋病毒的青少年（ALHIV）在继续参与护理和治疗项目方面面临许多障碍。与成年人相比，青少年的较高流失率仍然是一个巨大的问题，这是由于青少年面临独特的心理社会和卫生系统挑战，以及最近的 COVID-19 大流行的影响。我们报告了在纳米比亚温得和克接受抗逆转录病毒疗法（ART）的 10-19 岁青少年在护理中的保留率的决定因素和比率。 方法：对 2019 年 1 月至 2021 年 12 月期间在 13 个温得和克区公立医疗保健机构登记接受 ART 的 695 名 10-19 岁青少年的常规临床数据进行了回顾性队列分析。从电子数据库和登记册中提取匿名患者数据。进行了单变量和 Cox 比例风险分析，以确定与 ALHIV 在 6、12、18、24 和 36 个月时保留在护理中的因素。还使用 Kaplan-Meier 生存分析描述了保留在护理中的趋势。 结果：6、12、18、24 和 36 个月的保留在护理中的比率分别为 97.7%、94.1%、92.4%、90.2%和 84.6%。我们的研究人群主要是有治疗经验的青少年，他们在出生至 9 岁之间开始接受治疗（73.5%），治疗时间超过 24 个月（85.0%），并接受一线 ART（93.1%）。在控制混杂因素后，15-19 岁的青少年（aHR=1.964，95%CI 1.033-3.735）；接受转换后的 ART 方案（二线+三线方案）的青少年（aHR=4.024，95%CI 2.021-8.012）；15-19 岁开始接受 ART 的青少年（aHR=2.179，95%CI 1.100-4.316）；以及在 PHC 诊所接受 ART 的男性青少年（aHR=4.322，1.332-14.024）。相反，TB 筛查结果为阴性的青少年（aHR=0.215，95%CI 0.095-0.489）的青少年脱离护理的风险降低。 结论：温得和克的 ALHIV 保留在护理中的比率未达到 UNAIDS 修订的 95%目标。需要针对性别开展特定的干预措施，以保持男性和年龄较大的青少年保持长期护理的积极性和参与度，并促进那些在青春期后期（15-19 岁）开始接受 ART 的青少年的依从性。
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