title: Outcomes of antiretroviral therapy among younger versus older adolescents and adults in an urban clinic, Zimbabwe.
abstract: METHODS
  A non-governmental organisation-supported clinic offering health services including antiretroviral therapy (ART).
  
  
  OBJECTIVE
  To compare ART retention between younger (age 10-14 years) vs. older (age 15-19 years) adolescents and younger (age 20-29 years) vs. older (age ⩾30 years) adults and determine adolescent- and adult-specific attrition-associated factors among those initiated on ART between 2010 and 2011.
  
  
  METHODS
  Retrospective cohort study.
  
  
  RESULTS
  Of 110 (7%) adolescents and 1484 (93%) adults included in the study, no differences in retention were observed between younger vs. older adolescents at 6, 12 and 24 months. More younger adolescents were initiated with body mass index <16 kg/m(2) compared with older adolescents (64% vs. 47%; P = 0.04). There were more females (74% vs. 52%, P < 0.001) and fewer patients initiating ART with CD4 count ⩽350 cells/mm(3) (77% vs. 81%, P = 0.007) among younger vs. older adults. Younger adults demonstrated more attrition than older adults at all time-points. No attrition risk factors were observed among adolescents. Attrition-associated factors among adults included being younger, having a lower CD4 count and advanced human immunodeficiency virus disease at initiation, and initiation on a stavudine-based regimen.
  
  
  CONCLUSIONS
  Younger adults demonstrated greater attrition and may require more attention. We were unable to demonstrate differences in attrition among younger vs. older adolescents. Loss to follow-up was the main reason for attrition across all age groups. Overall, earlier presentation for ART care appears important for improved ART retention among adults.
authors.affiliation: Pharmaceutical Technology Department, Harare Institute of Technology, Harare, Zimbabwe.
authors.forename: C M J
authors.initials: CM
authors.lastname: Matyanga
authors.affiliation: AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe ; International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: K C
authors.initials: KC
authors.lastname: Takarinda
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Owiti
authors.affiliation: AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: T
authors.initials: T
authors.lastname: Mutasa-Apollo
authors.affiliation: AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: O
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: Pharmaceutical Technology Department, Harare Institute of Technology, Harare, Zimbabwe.
authors.forename: L
authors.initials: L
authors.lastname: Buruwe
authors.affiliation: Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: A J
authors.initials: AJ
authors.lastname: Reid
keywords: HIV/AIDS; SORT IT; attrition; operational research; retention