Loss to follow-up among children and adolescents growing up with HIV infection: age really matters

Katharina Kranzer, John Bradley, Joseph Musaazi, Mary Nyathi, Hilary Gunguwo, Wedu Ndebele, Mark Dixon, Mbongeni Ndhlovu, Andrea Rehman, Palwasha Khan, Florian Vogt, Tsitsi Apollo, Rashida Abbas Ferrand

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Introduction: Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from childhood through adolescence.

Methods: Individuals aged 5-19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5-9 (children), 10-14 (young adolescents) and 15-19 (older adolescents). The effect of age at ART initiation, current age (using a time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression.

Results: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5-9, 10-14 and 15-19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94-2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05-3.07). In older adolescents, the LTFU rate among those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age ( ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups.

Conclusions: Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.

Original languageEnglish
Article number21737
JournalJournal of the International AIDS Society
Number of pages7
Publication statusPublished - 2017


  • transition
  • adolescent
  • HIV
  • Africa
  • lost-to-follow-up
  • RISK


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