Attrition and treatment outcomes among adolescents and youths living with HIV in the Thai National AIDS Program
|Stephen J Kerr|
AbstractBackground: There are limited data describing the care outcome of youth living with HIV in Asia. We assessed attrition and treatment outcomes among youths with behaviourly acquired HI V (BIY) and adolescents with perinatally acquired HI V (PIY) who initiated antiretroviral treatment (ART) through the National AIDS Program (NAP) in Thailand. Methods: People living with HI V aged 10–24 years who initiated antiretroviral therapy (AR T) from 2008 to 2013 through the Thai NA P and who were followed up until 2014 were included in the analysis. We assessed youths initiating ART: BIY aged 15–19 years (BIY1) and BIY aged 20–24 (BIY2) compared against PIY aged 10–14 years. Attrition rates (mortality and loss to follow-up [LTFU]) were calculated and potential associations were assessed using Cox regression. Logistic regression was used to assess associations with treatment failure. Results: Of 11,954 individuals, 9909 (83%) were BIY with a median follow-up of 2.1 years and 17% were PIY with 4.2 years of follow-up. The median baseline CD4 cell count in BIY was higher (190 vs 154 cells/mm3) compared to PIY. Mortality rates were not significantly different among PIY (2.5 per 100 person years [PY], BIY1 3.1/100 PY and BIY2 2.9/100 PY, P=0.46). Compared to PIY with a crude LTFU rate of 2.9/100 PY, LTFU was higher in BIY1 (13.9/100 PY) and BIY2 (9.5/100 PY), P<0.001 and P<0.001, respectively. At 1 year after initiating AR T, 16% experienced virological failure (viral load above 1000 copies/mL). Combined treatment failure and LTFU rates at 1 year after AR T were higher among BIY1 (45.0%) and BIY2 (34.4%) compared to PIY (29.9%), P<0.001 and 0.001, respectively. Conclusion: Youth with behaviourally acquired HI V aged 15–19 years had poorer retention rates than older BIY and PIY. Targeted interventions for youth are urgently needed to improve overall treatment outcomes.