Post on 08-Feb-2016
description
HIV treatment outcomes among patients initiating ART from childhood through
late adolescence
Lucy Nganga
• In Kenya, most HIV+ children initiate ART in the pre-adolescent period
• Over time, these children transition from dependence on their guardians/caregivers to becoming independent
• A proportion of children initiate ART during early or late adolescence
• Limited data exist on outcomes of children initiating ART at different time points
Background
Introduction
AIDSRelief HIV Care and Treatment Programo 10 countrieso 8 years: 2004 to 2012o Funded by PEPFAR through HRSA & CDC
Kenya AIDSRelief o 29 faith-based facilities across the countryo December 31, 2012
o 72,333 patients initiated ARTo5,450 (8%) children and adolescents (5-19
years)
Objective
• To describe attrition rates among children initiating ART at different time points from pre-adolescence through to late adolescence
Methods
• Retrospective analysis of routinely collected data on children aged between 5 to 19 years
• 3 groups defined by age at ART initiation o Pre-adolescence (5-9 years)o Early adolescence (10-13 years) o Late adolescence (14-19 years)
• Attrition o Defined as Died or Lost to follow-up (LTFu) • Rates derived from Kaplan-Meier survival
probabilities
6
Baseline Characteristics
10
500
1000
1500
2000
2500
3000
Pre Adolescents Early Adolescents Late Adolescents
Nu
mb
er
of
Pati
en
ts
50% Female
52% Female
67% Female
Overalln=5,450 25% urban54% female2% pregnant
1,448 1,2102,792
Late Adolescen
ts14-19yrs
Early Adolescen
ts10-13yrs
Pre-Adolescents
5-9yrs
Lost to Follow-up by Age at ART Initiation
Mortality by Age at ART Initiation
Late Adolescen
ts14-19yrs
Early Adolescen
ts10-13yrs
Pre-Adolescents5-9yrs
Trends in Adolescent Attrition Rates by Age at ART Initiation
0
10
20
30
40
50
12m 24m 36m 48m 60m 72m 84m
Duration (Months) on ART
Att
riti
on R
ate
(%)
Early Adolescents
10-13yrs
Late Adolescents
14-19yrs
PreAdolescents
5-9yrs
Trends in Attrition by 1-Year Age Group
0
5
10
15
20
25
30
35
40
45
12m 24m 36m 48m 60m
Duration (Months) on ART
Att
riti
on R
ate
(%)
5-9y
Trends in Attrition by 1-Year Age Group
0
5
10
15
20
25
30
35
40
45
12m 24m 36m 48m 60m
Duration (Months) on ART
Att
riti
on R
ate
(%)
5-9yrs 10-13yrs
12 & 13y
5-9y
Trends in Attrition by 1-Year Age Group
0
5
10
15
20
25
30
35
40
45
12m 24m 36m 48m 60m
Duration (Months) on ART
Att
riti
on R
ate
(%)
5-9yrs 10-13yrs
12 & 13y
14y
14-19yrs
5-9y
Trends in Attrition by 1-Year Age Group
0
5
10
15
20
25
30
35
40
45
12m 24m 36m 48m 60m
Duration (Months) on ART
Att
riti
on R
ate
(%)
5-9yrs 10-13yrs
12 & 13y
14y
14-19yrs
15y
16y
5-9y
Trends in Attrition by 1-Year Age Group
0
5
10
15
20
25
30
35
40
45
12m 24m 36m 48m 60m
Duration (Months) on ART
Att
riti
on R
ate
(%)
5-9yrs 10-13yrs
12 & 13y
14y
14-19yrs
15y
16y
18y
17y
5-9y
Trends in Attrition by 1-Year Age Group
0
5
10
15
20
25
30
35
40
45
12m 24m 36m 48m 60m
Duration (Months) on ART
Att
riti
on R
ate
(%)
5-9yrs 10-13yrs
12 & 13y
14y
14-19yrs
15y16y
18y
17y
19y
5-9y
Conclusions
• Initiating ART in the pre- and early adolescence period appears to be protective against attrition
• However, transition from early to late adolescence maybe associated with an increase in attrition
• Starting treatment during late adolescence is associated with poorer outcomes (both LTFu and mortality)
Recommendations
• More needs to be done in order to develop a better understanding of the needs of this population as they transition through life while on treatment
• Strategies to support pediatric HIV services need to take into account the impact of age at ART initiation as well as transition into late adolescence while on ART
Acknowledgements
• Staff and patients
• AIDSRelief Consortiumo Catholic Relief Serviceso Futures Group International o University of Marylando Catholic Medical Missions Board
• Co-AuthorsOdhiambo F, Ojoo S, Ooko H, Githu C, Wandina D, Ngethe R, Burrows L
• HRSA & CDC