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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31828e1e2c
Implementation and Operational Research: Clinical Science

Nonadherence to Clinic Appointments Among HIV-Infected Children in an Ambulatory Care Program in Western Kenya

Nyandiko, Winstone MBChB, MMed, MPH*,†,‡; Vreeman, Rachel MD, MSc†,§; Liu, Hai PhD†,‖; Shangani, Sylvia Bsc, MPH†,‡; Sang, Edwin BSc; Ayaya, Samuel MBChB, MMed*,†,‡; Braitstein, Paula PhD†,¶,#,**

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Background: Nonadherence to clinic appointments is associated with poor outcomes in HIV-infected adults. We describe the effect of cumulative clinic adherence (CCA) to clinic appointments on mortality and loss to follow-up (LTFU) among HIV-infected children in Kenya.

Methods: We analyzed retrospective clinical data from HIV-infected children in the United States Agency for International Development–Academic Model Providing Access to Healthcare Partnership in Kenya between 2001 and 2009. We defined CCA as the proportion of days adherent to clinic visits after enrollment. We examined the effects of CCA on both death and LTFU, controlling for demographic and clinical factors at enrollment and over time. Cox proportional hazards models with time-varying coefficients were used to calculate adjusted hazard ratios (AHR) associated with each 10% increase in CCA on mortality and LTFU.

Results: Among 3255 HIV-infected children, 1668 (51.2%) were male, median enrollment age of 5.2 years (interquartile range: 3.6–7.4). Of 2393 children with CD4 within 3 months after enrollment, 1125 (47.0%) were severely immune suppressed, 567 became LTFU, and 88 died. Children with higher CCA had a higher risk of both mortality and LTFU at 3 and 6 months. Higher CCA became protective at 24 months for mortality, AHR at 24 months: 0.7 (95% confidence interval: 0.6 to 0.9), and at 12 months for LTFU, AHR at 24 months: 0.7 (95% confidence interval: 0.7 to 0.7).

Conclusions: Children adherence to clinic visits during the first 6 months of HIV care was associated with a higher risk of death and LTFU, but by 24 months, children with better CCA had a reduced risk of LTFU and mortality.

© 2013 by Lippincott Williams & Wilkins


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