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Dual Analysis of Loss to Follow-up for Perinatally HIV-Infected Adolescents Receiving Combination Antiretroviral Therapy in Asia

Bartlett, Adam W. MBBSa; Lumbiganon, Pagakrong MDb; Jamal Mohamed, Thahira A. MBBSc; Lapphra, Keswadee MDd; Muktiarti, Dina MDe; Du, Quy Tuan MDf; Hansudewechakul, Rawiwan MDg; Ly, Penh Sun MDh; Truong, Khanh Huu MDf; Van Nguyen, Lam MDi; Puthanakit, Thanyawee MDj,k; Sudjaritruk, Tavitiya MD, ScM, PhDl; Chokephaibulkit, Kulkanya MDd; Do, Viet Chau MDm; Kumarasamy, Nagalingeswaran MBBSn; Nik Yusoff, Nik Khairulddin MBBS, DTM&Ho; Kurniati, Nia MD, PhDe; Fong, Moy Siew MBBSp; Wati, Dewi Kumara MDq; Nallusamy, Revathy MBBSr; Sohn, Annette H. MDs; Kariminia, Azar PhDa for the TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15, 2019 - Volume 82 - Issue 5 - p 431–438
doi: 10.1097/QAI.0000000000002184
Implementation Science

Background: Perinatally HIV-infected adolescents (PHIVA) are an expanding population vulnerable to loss to follow-up (LTFU). Understanding the epidemiology and factors for LTFU is complicated by varying LTFU definitions.

Setting: Asian regional cohort incorporating 16 pediatric HIV services across 6 countries.

Methods: Data from PHIVA (aged 10–19 years) who received combination antiretroviral therapy 2007–2016 were used to analyze LTFU through (1) an International epidemiology Databases to Evaluate AIDS (IeDEA) method that determined LTFU as >90 days late for an estimated next scheduled appointment without returning to care and (2) the absence of patient-level data for >365 days before the last data transfer from clinic sites. Descriptive analyses and competing-risk survival and regression analyses were used to evaluate LTFU epidemiology and associated factors when analyzed using each method.

Results: Of 3509 included PHIVA, 275 (7.8%) met IeDEA and 149 (4.3%) met 365-day absence LTFU criteria. Cumulative incidence of LTFU was 19.9% and 11.8% using IeDEA and 365-day absence criteria, respectively. Risk factors for LTFU across both criteria included the following: age at combination antiretroviral therapy initiation <5 years compared with age ≥5 years, rural clinic settings compared with urban clinic settings, and high viral loads compared with undetectable viral loads. Age 10–14 years compared with age 15–19 years was another risk factor identified using 365-day absence criteria but not IeDEA LTFU criteria.

Conclusions: Between 12% and 20% of PHIVA were determined LTFU with treatment fatigue and rural treatment settings consistent risk factors. Better tracking of adolescents is required to provide a definitive understanding of LTFU and optimize evidence-based models of care.

aThe Kirby Institute, UNSW Australia, Sydney, Australia;

bDepartment of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;

cPediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia;

dDepartment of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand;

eCipto Mangunkusumo—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia;

fChildren's Hospital 1, Ho Chi Minh City, Vietnam;

gChiangrai Prachanukroh Hospital, Chiang Rai, Thailand;

hNational Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia;

iNational Hospital of Pediatrics, Hanoi, Vietnam;

jThe HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand;

kDepartment of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

lDepartment of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand;

mChildren's Hospital 2, Ho Chi Minh City, Vietnam;

nChennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India;

oHospital Raja Perempuan Zainab II, Kelantan, Malaysia;

pHospital Likas, Kota Kinabalu, Malaysia;

qSanglah Hospital, Udayana University, Bali, Indonesia;

rPenang Hospital, Penang, Malaysia; and

sTREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand.

Correspondence to: Adam W. Bartlett, MBBS, Kirby Institute, Wallace Wurth Building, University of New South Wales, Sydney, New South Wales, Australia 2052 (e-mail:

Supported by the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, National Institute of Mental Health, National Institute on Drug Abuse as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA) (Grant number U01AI069907), and the Australian Government Department of Health and Ageing. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above.

A.W.B. received support from an Australian Government Department of Research Training Program Scholarship and has received grant support to his institution from Gilead. A.H.S. has received travel and grant support to her institution from ViiV HealthCare. The remaining authors have no conflicts of interest to disclose.

Received May 15, 2019

Accepted August 05, 2019

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