title: Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria.
abstract: Interruptions in HIV care are a major cause of morbidity and mortality, particularly in resource-limited settings. We compared engagement in care and virologic outcomes between HIV-infected adolescents and young adults (AYA) and older adults (OA) one year after starting antiretroviral therapy (ART) in Nigeria.
  
  
  
  We conducted a retrospective cohort study of AYA (15-24 years) and OA (>24 years) who initiated ART from 2009-2011. We used negative binomial regression to model the risk of inconsistent care and viremia (HIV RNA >1,000 copies/mL) among AYA and OA in the first year on ART. Regular care included monthly ART pickup and 3-monthly clinical visits. Patients with ≤3 months between consecutive visits were considered in care. Those with inconsistent care had >3 months between consecutive visits.
  
  
  
  The cohort included 354 AYA and 2,140 OA. More AYA than OA were female (89% vs. 65%, p < .001). Median baseline CD4 was 252/μL in AYA and 204/μL in OA (p = .002). More AYA had inconsistent care than OA (55% vs. 47%, p = .001). Adjusting for sex, baseline CD4, and education, AYA had a greater risk of inconsistent care than OA (Relative Risk [RR]: 1.15, p = .008). Among those in care after one year on ART, viremia was more common in AYA than OA (40% vs. 26% p = .003, RR: 1.53, p = .002).
  
  
  
  In a Nigerian cohort, AYA were at increased risk for inconsistent HIV care. Of patients remaining in care, youth was the only independent predictor of viremia at 1 year. Youth-friendly models of HIV care are needed to optimize health outcomes.
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: aahonkhai@mgh.harvard.edu.
authors.forename: Aimalohi A
authors.initials: AA
authors.lastname: Ahonkhai
authors.affiliation: AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria.
authors.forename: Bolanle
authors.initials: B
authors.lastname: Banigbe
authors.affiliation: AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria.
authors.forename: Juliet
authors.initials: J
authors.lastname: Adeola
authors.affiliation: Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Abdulkabir B
authors.initials: AB
authors.lastname: Adegoke
authors.affiliation: Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
authors.affiliation: Nigerian Institute for Medical Research, Lagos, Nigeria.
authors.forename: Ifeoma
authors.initials: I
authors.lastname: Idigbe
authors.affiliation: Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Prosper
authors.initials: P
authors.lastname: Okonkwo
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D019562:Viral Load / Q000187:drug effects; D014766:Viremia / Q000453:epidemiology*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: ART; Adolescents; HIV; Inconsistent care; Older adults; Resource-limited setting; Retention; Viremia; Young adults