title: Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya.
abstract: BACKGROUND
  The number of youth and adolescents (10-24 years) with HIV infection has increased substantially presenting unique challenges to effective health service delivery.
  
  
  METHODS
  We examined routinely collected patient-level data for antiretroviral treatment (ART)-naive HIV-infected patients, aged 10-24 years, enrolled in care during 2006-2011 at 109 ICAP-supported health facilities in three provinces in Kenya. Loss to follow-up (LTF) was defined as having no clinic visit for 12 months prior to ART initiation (pre-ART) and 6 months for ART patients. Competing risk and Kaplan-Meier estimators were used to calculate LTF and death rates. Sub-distributional and Cox proportional-hazards models were used to identify potential predictors of death and LTF.
  
  
  RESULTS
  Overall 22 832 patients were enrolled in care at 10-24 years of age, 69.5% were aged 20-24 years, and 82% were female. Median CD4(+) cell count was 332 cells/μl (interquartile range 153-561); 70.8% were WHO stage I/II. Young adolescents (10-14 years) had more advanced WHO stage and lower median CD4(+) cell count compared to youth (15-24 years) at enrollment (284 vs. 340 cells/μl; P < 0.0001). Cumulative incidence of LTF and death at 24 months for pre-ART patients was 46.1% [95% confidence interval (CI) 45.4-46.8%) and 2.1% (95% CI 1.9-2.3%), respectively. For those on ART, 32.2% (95% CI 31.1-33.3%) were LTF and 3.9% (95% CI 1.7-2.3%) died within 24 months. LTF among pre-ART and ART patients was twice as high among youth compared to young adolescents.
  
  
  CONCLUSIONS
  LTF of young people with HIV in this Kenyan cohort was high and notably greater among youth compared to young adolescents. Novel strategies targeting these populations are urgently needed to improve retention.
authors.affiliation: aICAP-Columbia University, New York bDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA cNational AIDS & STI Control Program, Ministry of Health, Nairobi, Kenya dCollege of Physicians & Surgeons, Columbia University, New York, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Koech
authors.forename: Chloe A
authors.initials: CA
authors.lastname: Teasdale
authors.forename: Chunhui
authors.initials: C
authors.lastname: Wang
authors.forename: Ruby
authors.initials: R
authors.lastname: Fayorsey
authors.forename: Terezah
authors.initials: T
authors.lastname: Alwar
authors.forename: Irene N
authors.initials: IN
authors.lastname: Mukui
authors.forename: Mark
authors.initials: M
authors.lastname: Hawken
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D015994:Incidence; D007630:Kenya; D059012:Lost to Follow-Up; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents