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HIV treatment outcomes among patients initiating ART from childhood through late adolescence

HIV treatment outcomes among patients initiating ART from childhood through late adolescence. Lucy Nganga. Background. In Kenya, most HIV+ children initiate ART in the pre-adolescent period

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HIV treatment outcomes among patients initiating ART from childhood through late adolescence

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  1. HIV treatment outcomes among patients initiating ART from childhood throughlate adolescence Lucy Nganga

  2. Background • 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

  3. Introduction AIDSRelief HIV Care and Treatment Program • 10 countries • 8 years: 2004 to 2012 • Funded by PEPFAR through HRSA & CDC Kenya AIDSRelief • 29 faith-based facilities across the country • December 31, 2012 • 72,333 patients initiated ART • 5,450 (8%) children and adolescents (5-19 years)

  4. Objective • To describe attrition rates among children initiating ART at different time points from pre-adolescence through to late adolescence

  5. Methods • Retrospective analysis of routinely collected data on children aged between 5 to 19 years • 3 groups defined by age at ART initiation • Pre-adolescence (5-9 years) • Early adolescence (10-13 years) • Late adolescence (14-19 years) • Attrition • Defined as Died or Lost to follow-up (LTFu) • Rates derived from Kaplan-Meier survival probabilities

  6. Baseline Characteristics 2,792

  7. Lost to Follow-up by Age at ART Initiation Pre-Adolescents 5-9yrs Early Adolescents 10-13yrs Late Adolescents 14-19yrs

  8. Mortality by Age at ART Initiation Pre-Adolescents 5-9yrs Early Adolescents 10-13yrs Late Adolescents 14-19yrs

  9. Trends in Adolescent Attrition Rates by Age at ART Initiation Early Adolescents 10-13yrs Late Adolescents 14-19yrs Pre Adolescents 5-9yrs

  10. Trends in Attrition by 1-Year Age Group 5-9y

  11. Trends in Attrition by 1-Year Age Group 5-9yrs 10-13yrs 12 & 13y 5-9y

  12. Trends in Attrition by 1-Year Age Group 5-9yrs 10-13yrs 14-19yrs 14y 12 & 13y 5-9y

  13. Trends in Attrition by 1-Year Age Group 5-9yrs 10-13yrs 14-19yrs 15y 16y 14y 12 & 13y 5-9y

  14. Trends in Attrition by 1-Year Age Group 5-9yrs 10-13yrs 14-19yrs 18y 17y 15y 16y 14y 12 & 13y 5-9y

  15. Trends in Attrition by 1-Year Age Group 5-9yrs 10-13yrs 14-19yrs 18y 17y 19y 15y 16y 14y 12 & 13y 5-9y

  16. 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)

  17. 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

  18. Acknowledgements • Staff and patients • AIDSRelief Consortium • Catholic Relief Services • Futures Group International • University of Maryland • Catholic Medical Missions Board • Co-Authors Odhiambo F, OjooS,Ooko H, GithuC, WandinaD, Ngethe R, Burrows L • HRSA & CDC

  19. Thank You

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