Hicks Sarah, Jiang Wenwen, Kibugi James, Badia Jacinta, Richardson Barbra A, Beima-Sofie Kristin, Agot Kawango, Kohler Pamela, John-Stewart Grace
Department of Epidemiology.
Department of Global Health, University of Washington, Seattle, WA, USA.
AIDS. 2025 Jun 1;39(7):886-898. doi: 10.1097/QAD.0000000000004141. Epub 2025 Feb 4.
This study aimed to identify age-specific cofactors of nonretention among adolescents and young adults with HIV (AYHIV) ages 10-24.
This analysis used data from the Data-Informed Stepped Care study (DiSC; NCT05007717), a cluster randomized clinical trial in 24 health facilities in Western Kenya.
During 12-month follow-up, youth-reported cofactors of missed visits and loss-to-follow-up (LTFU; did not return to clinic within study period) were assessed using generalized linear and mixed effect models and stratified by gender and age.
Among 1904 AYHIV, median age was 17 years (interquartile range 14-19), and 57.9% were female. A higher proportion of missed visits was observed in older ages (10-14: 6.0%; 15-19: 7.9%; 20-24: 12.5%). Overall, higher resilience (prevalence ratio (PR) = 0.93) and satisfaction with clinic (PR = 0.81) were associated with lower risk of missed visits. Among males, satisfaction with clinic was associated with lower risk (PR = 0.61) while higher stigma was associated with increased risk (PR = 1.31). Among females, resilience was associated with lower risk (PR = 0.93). Having no living parents was associated with higher LTFU risk (PR = 2.24). Among males, horizontal transmission was associated with higher risk (PR = 2.98) and resilience with lower risk (PR = 0.76). Females who came to clinic alone had lower risk of LTFU (PR = 0.27). Age-stratified analyses did not identify additional cofactors.
In this large multisite cohort, older AYHIV had the most retention challenges. Resilience, satisfaction with clinical care, and stigma exerted an influential role, but cofactors differed between age and gender strata, underscoring the heterogeneity of AYHIV and suggesting need for tailored approaches.
本研究旨在确定年龄在10至24岁的感染艾滋病毒的青少年和青年（AYHIV）中与未坚持治疗相关的特定年龄协变量。
本分析使用了数据驱动的逐步护理研究（DiSC；NCT05007717）的数据，这是一项在肯尼亚西部24个医疗机构进行的整群随机临床试验。
在12个月的随访期间，使用广义线性和混合效应模型评估青少年报告的错过就诊和失访（LTFU；在研究期间未返回诊所）的协变量，并按性别和年龄分层。
在1904名AYHIV患者中，中位年龄为17岁（四分位间距14 - 19岁），57.9%为女性。年龄较大者错过就诊的比例更高（10 - 14岁：6.0%；15 - 19岁：7.9%；20 - 24岁：12.5%）。总体而言，更强的适应力（患病率比（PR） = 0.93）和对诊所的满意度（PR = 0.81）与错过就诊的风险较低相关。在男性中，对诊所的满意度与较低风险相关（PR = 0.61），而较高的耻辱感与风险增加相关（PR = 1.31）。在女性中，适应力与较低风险相关（PR = 0.93）。没有在世父母与较高的失访风险相关（PR = 2.24）。在男性中，水平传播与较高风险相关（PR = 2.98），适应力与较低风险相关（PR = 0.76）。独自前来诊所的女性失访风险较低（PR = 0.27）。年龄分层分析未发现其他协变量。
在这个大型多地点队列中，年龄较大的AYHIV患者面临的坚持治疗挑战最大。适应力、对临床护理的满意度和耻辱感发挥了重要作用，但协变量在年龄和性别层之间存在差异，这突出了AYHIV的异质性，并表明需要采取针对性的方法。
