MOPED617

Title

Mortality and loss to follow-up among HIV positive adolescents and young adults in program settings in Kenya

Presenter

Irene Njuguna

Authors

I. Njuguna¹, J. Neary², K. Beima-Sofie², C. Mburu³, C. Mugo¹, J. Itindi⁴, A. Onyango³, D. Black², B. Richardson², L. Oyiengo⁵, D. Wamalwa³, G. John-Stewart²

Institutions

¹Kenyatta National Hospital, Nairobi, Kenya, ²University of Washington School of Public Health, Seattle, United States, ³University of Nairobi, Pediatrics and Child Health, Nairobi, Kenya, ⁴Kenya Medical Research Institute (KEMRI), Nairobi, Kenya, ⁵National AIDS & STI Control Program, Ministry of Health, Nairobi, Kenya

Background: Mortality among HIV-infected adolescents in sub-Saharan Africa remains high compared to other age-groups. Within programs, little is known about characteristics of adolescent mortality.
Methods: As part of an ongoing trial (NCT03574129), we abstracted routine adolescent and young adult (AYA) (ages 10-24 years) records from 87 HIV clinics in Kenya, randomly selected from a national pool of clinics using electronic medical records. Records of AYA who had ≥1 clinic visit between January 2016 and December 2017 were reviewed to identify AYA outcomes among AYA with at least 6 months potential follow-up time. AYA who died or were LTFU were compared to AYA continuing follow-up using logistic regression.
Results: Of 6537 AYA with ≥1 clinic visit between January 2016 and June 2017, 191 (3%) died, 1654 (25%) were lost to follow-up, 601 (9%) transferred out and 4091 (63%) continued to attend clinic.
Among 191 AYA who died, median age was 18 years (IQR 14, 22), with 30%, 32% and 38% in the 10-14, 15-19 and 20-24 year age-groups, respectively. Fifty percent were female, 84% were single, and 54% reported a parent as a support person.
Comparing those who died to those in follow-up, those in the 15-19 and 20-24 year age-group had 1.35 (95% CI 0.93, 1.94; p=0.11) and 1.97 (95% CI 1.38, 2.81; p < 0.001) higher odds of death than those in the 10-14 year age-group. Male AYA were more likely to die (6% vs. 4%; OR: 1.48 95% CI 1.20, 1.99; p =0.009). Comparing lost to follow-up to those still in follow-up, those in 15-19 and 20-24 year age-groups had a significantly higher odds of becoming lost to follow-up than those in the 10-14 year age group (p< 0.001 for both). In contrast to mortality, females were more likely to become lost to follow-up (32% vs. 23%, p< 0.001).
Conclusions: In this programmatic analysis, mortality and loss to follow-up among AYA in HIV care was high. Mortality was higher and retention lower among older AYA (ages 15-24). Males were more likely to die while females had higher non-retention. Defining determinants of mortality and non-retention in youth will be important to tailoring interventions.

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