title: Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013.
abstract: Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged ≥50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p<0.001), employed (p<0.001), and married, (p<0.05 in five countries). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries in crude and multivariable analyses. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Auld
authors.forename: Simon G
authors.initials: SG
authors.lastname: Agolory
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shiraishi
authors.forename: Fred
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authors.lastname: Wabwire-Mangen
authors.forename: Gideon
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authors.lastname: Kwesigabo
authors.forename: Modest
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authors.lastname: Mulenga
authors.forename: Sebastian
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authors.lastname: Hachizovu
authors.forename: Emeka
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authors.lastname: Asadu
authors.forename: Moise Zanga
authors.initials: MZ
authors.lastname: Tuho
authors.forename: Virginie
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authors.lastname: Ettiegne-Traore
authors.forename: Francisco
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authors.lastname: Mbofana
authors.forename: Velephi
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authors.lastname: Okello
authors.forename: Charles
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authors.lastname: Azih
authors.forename: Julie A
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authors.lastname: Denison
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authors.lastname: Tsui
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authors.lastname: Koole
authors.forename: Harrison
authors.initials: H
authors.lastname: Kamiru
authors.forename: Harriet
authors.initials: H
authors.lastname: Nuwagaba-Biribonwoha
authors.forename: Charity
authors.initials: C
authors.lastname: Alfredo
authors.forename: Kebba
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authors.lastname: Jobarteh
authors.forename: Solomon
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authors.lastname: Odafe
authors.forename: Dennis
authors.initials: D
authors.lastname: Onotu
authors.forename: Kunomboa A
authors.initials: KA
authors.lastname: Ekra
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Kouakou
authors.forename: Peter
authors.initials: P
authors.lastname: Ehrenkranz
authors.forename: George
authors.initials: G
authors.lastname: Bicego
authors.forename: Kwasi
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authors.lastname: Torpey
authors.forename: Ya Diul
authors.initials: YD
authors.lastname: Mukadi
authors.forename: Eric
authors.initials: E
authors.lastname: van Praag
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Timothy
authors.initials: T
authors.lastname: Mastro
authors.forename: Carol
authors.initials: C
authors.lastname: Dukes Hamilton
authors.forename: Mahesh
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authors.lastname: Swaminathan
authors.forename: E Kainne
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authors.lastname: Dokubo
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Baughman
authors.forename: Thomas
authors.initials: T
authors.lastname: Spira
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: David
authors.initials: D
authors.lastname: Bangsberg
authors.forename: Richard
authors.initials: R
authors.lastname: Marlink
authors.forename: Aaron
authors.initials: A
authors.lastname: Zee
authors.forename: Jonathan
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authors.lastname: Kaplan
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authors.initials: TV
authors.lastname: Ellerbrock
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents