title: Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe.
abstract: BACKGROUND
  Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown.
  
  
  OBJECTIVE
  To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents.
  
  
  METHODS
  We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models.
  
  
  RESULTS
  Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively.
  
  
  CONCLUSIONS
  Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescents' needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.
authors.affiliation: *Institute of Tropical Medicine Antwerp, Antwerp, Belgium; †London School of Hygiene and Tropical Medicine, London, United Kingdom; ‡National and Supranational Reference Laboratory, Research Centre Leibnitz, Borstel, Germany; §Mpilo Central Hospital, Bulawayo, Zimbabwe; ‖National University of Science and Technology, Bulawayo, Zimbabwe; ¶University of Antwerp, Antwerp, Belgium; #Ministry of Health and Child Welfare, Harare, Zimbabwe; **University of Zimbabwe, Harare, Zimbabwe; and ††Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Florian
authors.initials: F
authors.lastname: Vogt
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Rehman
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.forename: Mary
authors.initials: M
authors.lastname: Nyathi
authors.forename: Johan
authors.initials: J
authors.lastname: Van Griensven
authors.forename: Mark
authors.initials: M
authors.lastname: Dixon
authors.forename: Wedu
authors.initials: W
authors.lastname: Ndebele
authors.forename: Hilary
authors.initials: H
authors.lastname: Gunguwo
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Mbongeni
authors.initials: M
authors.lastname: Ndlovu
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Apollo
authors.forename: Rashida A
authors.initials: RA
authors.lastname: Ferrand
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D037001:Directive Counseling / Q000379:methods; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D059012:Lost to Follow-Up; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects*; D015030:Zimbabwe / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents