title: Patterns of Adherence and Loss to Follow-Up in Pediatric Patients on ART in Nigeria.
abstract: BACKGROUND
  High levels of adherence to antiretroviral therapy (ART) and retention in treatment programs are required for successful virologic suppression and treatment outcomes. While there have been numerous studies focusing on adherence and loss to follow-up (LTFU) in adults, studies in children and young adolescents are limited. For this study, we examined patterns of adherence and LTFU in HIV-infected pediatric patients receiving ART in PEPFAR-funded sites in Nigeria.
  
  
  METHODS
  We conducted a retrospective observational study utilizing data that had been collected during the course of care in a large pediatric ART program in Nigeria.
  
  
  RESULTS
  A total of 3,513 children ages 0-14.9 years enrolled at 31 different sites between June 2005 and March 2011 were included in the study. Of the enrolled patients, 1,987 (56%) were LTFU by the end of the study period. LTFU was highest in those ages<2 years and those≥13 years (versus aged 2-12.9 years). Year of ART initiation was a strong predictor of LTFU across all age groups. For those patients retained to 12 months, less than half showed optimal adherence (≥95%). While there were no differences in adherence rates at month 12 by age group, those aged 10 years and older did have declining adherence starting at 18 months.
  
  
  CONCLUSIONS
  Adherence is critical for optimal ART patient outcomes. We found both low adherence and high LTFU rates in our study cohort. Additional studies focused on barriers to adherence and development of age-specific intervention programs are critical to improving overall pediatric outcomes.
authors.forename: Seema T
authors.initials: ST
authors.lastname: Meloni
authors.forename: Beth
authors.initials: B
authors.lastname: Chaplin
authors.forename: Charlotte
authors.initials: C
authors.lastname: Chang
authors.forename: Holly
authors.initials: H
authors.lastname: Rawizza
authors.forename: Prosper
authors.initials: P
authors.lastname: Okonkwo
authors.affiliation: Harvard School of Public Health, Department of Immunology and Infectious Diseases, 651 Huntington Avenue, FXB 405, Boston, MA 02115, USA. pkanki@hsph.harvard.edu.
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Kanki
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence; D009549:Nigeria; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents