Zimbabwe: High risk of death among adolescents while awaiting ART

Shroufi A, Ndebele W, Nyathi M, Gunguwo H, Dixon M, Saint-Sauveur JF, Taziwa F, Vinoles MC, Ferrand RA

Introduction: Mortality among HIV-positive adults awaiting antiretroviral therapy (ART) has previously been found to be high. Here, we compare adolescent pre-ART mortality to that of adults in a public sector HIV care programme in Bulawayo, Zimbabwe.

Methods: In this retrospective cohort study, we compared adolescent pre-ART outcomes with those of adults enrolled for HIV care in the same clinic. Adolescents were defined as those aged 10-19 at the time of registration. Comparisons of means and proportions were carried out using two-tailed sample t-tests and chi-square tests respectively, for normally distributed data, and the Mann-Whitney U-tests for non-normally distributed data. Loss to follow-up (LTFU) was defined as missing a scheduled appointment by three or more months.

Results: Between 2004 and 2010, 1382 of 1628 adolescents and 7557 of 11 106 adults who registered for HIV care met the eligibility criteria for ART. Adolescents registered at a more advanced disease stage than did adults (83% vs. 73% WHO stage III/IV, respectively, pand the median time to ART initiation was longer for adolescents than for adults [21 (10-55) days vs. 15 (7-42) days, pMortality among treatment-eligible adolescents awaiting ART was significantly higher than among adults (3% vs. 1.8%, respectively, p=0.004).

Conclusions: Adolescents present to ART services at a later clinical stage than adults and are at an increased risk of death prior to commencing ART. Improved and innovative HIV case-finding approaches and emphasis on prompt ART initiation in adolescents are urgently needed. Following registration, defaulter tracing should be used, whether or not ART has been commenced.

July 7, 2015
Year of publication
2015
Resource types
Journal and research articles
Tags
treatment, ART, ARVs, antiretroviral therapy, antiretroviral drugs, pre-ART mortality, adolescents, pre-ART outcomes, HIV case-finding approaches, early ART initiation

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