title: Antiretroviral therapy outcomes among adolescents and youth in rural Zimbabwe.
abstract: Around 2 million adolescents and 3 million youth are estimated to be living with HIV worldwide. Antiretroviral outcomes for this group appear to be worse compared to adults. We report antiretroviral therapy outcomes from a rural setting in Zimbabwe among patients aged 10-30 years who were initiated on ART between 2005 and 2008. The cohort was stratified into four age groups: 10-15 (young adolescents) 15.1-19 years (adolescents), 19.1-24 years (young adults) and 24.1-29.9 years (older adults). Survival analysis was used to estimate rates of deaths and loss to follow-up stratified by age group. Endpoints were time from ART initiation to death or loss to follow-up. Follow-up of patients on continuous therapy was censored at date of transfer, or study end (31 December 2008). Sex-adjusted Cox proportional hazards models were used to estimate hazard ratios for different age groups. 898 patients were included in the analysis; median duration on ART was 468 days. The risk of death were highest in adults compared to young adolescents (aHR 2.25, 95%CI 1.17-4.35). Young adults and adolescents had a 2-3 times higher risk of loss to follow-up compared to young adolescents. When estimating the risk of attrition combining loss to follow-up and death, young adults had the highest risk (aHR 2.70, 95%CI 1.62-4.52). This study highlights the need for adapted adherence support and service delivery models for both adolescents and young adults.
authors.affiliation: Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa. Helen.bygrave@joburg.msf.org
authors.forename: Helen
authors.initials: H
authors.lastname: Bygrave
authors.forename: Judith
authors.initials: J
authors.lastname: Mtangirwa
authors.forename: Kwenzakwenkosi
authors.initials: K
authors.lastname: Ncube
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.forename: Dhodho
authors.initials: D
authors.lastname: Munyaradzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D012424:Rural Population; D016896:Treatment Outcome; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology