Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of the International AIDS Society
Abstract
As access to antiretroviral therapy (ART) increases, the success of treatment programmes depends on ensuring
high patient retention in HIV care. We examined retention and attrition among adolescents in ART programmes across clinics
operated by The AIDS Support Organization (TASO) in Uganda, which has operated both facility- and community-based
distribution models of ART delivery since 2004.
Methods: Using a retrospective cohort analysis of patient-level clinical data, we examined attrition and retention in HIV care and
factors associated with attrition among HIV-positive adolescents aged 10 19 years who initiated ART at 10 TASO clinics between
January 2006 and December 2011. Retention in care was defined as the proportion of adolescents who had had at least one
facility visit within the six months prior to 1 June 2013, and attrition was defined as the proportion of adolescents who died,
were lost to follow-up, or stopped treatment. Descriptive statistics and Cox proportional hazards regression models were used to
determine the levels of retention in HIV care and the factors associated with attrition following ART initiation.
Results: A total of 1228 adolescents began ART between 2006 and 2011, of whom 57% were female. The median duration in HIV
care was four years (IQR 3 6 years). A total of 792 (65%) adolescents were retained in care over the five-year period; 36 (3%)
had died or transferred out and 400 (32%) were classified as loss to follow-up. Factors associated with attrition included being
older (adjusted hazard ratio (AHR) 1.38, 95% confidence interval (CI) 1.02 1.86), having a higher CD4 count (250 cells/mm3)
at treatment initiation (AHR 0.49, 95% CI 0.34 0.69) and HIV care site with a higher risk of attrition among adolescents in Gulu
(AHR 2.26; 95% CI 1.27 4.02) and Masindi (AHR 3.30, 95% CI 1.87 5.84) and a lower risk of attrition in Jinja (AHR 0.24,
95% CI 0.08 0.70). Having an advanced WHO clinical stage at initiation was not associated with attrition.
Conclusions: We found an overall retention rate of 65%, which is comparable to rates achieved by TASO’s adult patients and
adolescents in other studies in Africa. Variations in the risk of attrition by TASO treatment site and by clinical and demographic
characteristics suggest the need for early diagnosis of HIV infection, use of innovative approaches to reach and retain
adolescents living with HIV in treatment and identifying specific groups, such as older adolescents, that are at high risk of
dropping out of treatment for targeted care and support.
Description
Keywords
Adolescents, HIV treatment, Antiretroviral therapy, Retention, Attrition, Community-based delivery, Uganda
Citation
Okoboi, S., Ssali, L., Yansaneh, A. I., Bakanda, C., Birungi, J., Nantume, S., ... & Kalibala, S. (2016). Factors associated with long‐term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study. Journal of the International AIDS Society, 19, 20841. http://dx.doi.org/10.7448/IAS.19.5.20841