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

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