Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe
BACKGROUND:Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is c...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2017-04, Vol.74 (4), p.390-398 |
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| container_title | Journal of acquired immune deficiency syndromes (1999) |
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| creator | Vogt, Florian Rehman, Andrea M Kranzer, Katharina Nyathi, Mary Van Griensven, Johan Dixon, Mark Ndebele, Wedu Gunguwo, Hilary Colebunders, Robert Ndlovu, Mbongeni Apollo, Tsitsi Ferrand, Rashida A |
| description | BACKGROUND:Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown.
OBJECTIVE:To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents.
METHODS:We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to 14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively.
CONCLUSIONS:Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescentsʼ needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up. |
| doi_str_mv | 10.1097/QAI.0000000000001274 |
| format | Article |
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OBJECTIVE:To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents.
METHODS:We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models.
RESULTS:Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively.
CONCLUSIONS:Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescentsʼ needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0000000000001274</identifier><identifier>PMID: 28002183</identifier><identifier>CODEN: JDSRET</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>AIDS/HIV ; Antiretroviral drugs ; Implementation Science ; Lentivirus ; Medical treatment ; Mortality ; Regression analysis ; Retention ; Retroviridae ; Teenagers</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2017-04, Vol.74 (4), p.390-398</ispartof><rights>Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams & Wilkins Apr 1, 2017</rights><rights>Copyright © 2016 The Author(s). Published by Wolters Kluwer Health, Inc. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5184-e35bea03744c97386966d3c4c8358c9c07369af5475b5a81dd0f232db77d35083</citedby><cites>FETCH-LOGICAL-c5184-e35bea03744c97386966d3c4c8358c9c07369af5475b5a81dd0f232db77d35083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28002183$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vogt, Florian</creatorcontrib><creatorcontrib>Rehman, Andrea M</creatorcontrib><creatorcontrib>Kranzer, Katharina</creatorcontrib><creatorcontrib>Nyathi, Mary</creatorcontrib><creatorcontrib>Van Griensven, Johan</creatorcontrib><creatorcontrib>Dixon, Mark</creatorcontrib><creatorcontrib>Ndebele, Wedu</creatorcontrib><creatorcontrib>Gunguwo, Hilary</creatorcontrib><creatorcontrib>Colebunders, Robert</creatorcontrib><creatorcontrib>Ndlovu, Mbongeni</creatorcontrib><creatorcontrib>Apollo, Tsitsi</creatorcontrib><creatorcontrib>Ferrand, Rashida A</creatorcontrib><title>Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>BACKGROUND:Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown.
OBJECTIVE:To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents.
METHODS:We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models.
RESULTS:Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively.
CONCLUSIONS:Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescentsʼ needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.</description><subject>AIDS/HIV</subject><subject>Antiretroviral drugs</subject><subject>Implementation Science</subject><subject>Lentivirus</subject><subject>Medical treatment</subject><subject>Mortality</subject><subject>Regression analysis</subject><subject>Retention</subject><subject>Retroviridae</subject><subject>Teenagers</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqNksFu1DAQhiMEoqXwBghZ4sJlix3bscMBKawKrFSpogoXLpaTTBoXJ97aTlf7HLww3t1SlR4Qc7Gl-f5fM6M_y14TfEpwKd5_q1an-EGRXLAn2TEpGVsIKdnT9Oc5XzBC-VH2IoTrxBSMlc-zo1xinBNJj7Nfl2B1NG4Kg1mjTxA3ABOqzQgoOrSaTDT7NnI9qqZoPETvbo3XFtUDeL3eIj11qPag4whTRBdzbN0I4QOq0NINzsek03YbTNh7XNbozJor01hAVecshDbJAjIT-mHGRjcbeJk967UN8OruPcm-fz6rl18X5xdfVsvqfNFyItkCKG9AYyoYa0tBZVEWRUdb1krKZVu2WNCi1D1ngjdcS9J1uM9p3jVCdJRjSU-yjwff9dyM0O3mSHuptTej9lvltFF_dyYzqCt3qzjNSapk8O7OwLubGUJUo0nrWKsncHNQRAohWZqD_gfKSVHmgouEvn2EXrvZpxvuDXNe4JLuKHagWu9C8NDfz02w2gVEpYCoxwFJsjcPd74X_UlEAuQB2DgbwYefdt6AVwNoG4d_e_8G7tLIDQ</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Vogt, Florian</creator><creator>Rehman, Andrea M</creator><creator>Kranzer, Katharina</creator><creator>Nyathi, Mary</creator><creator>Van Griensven, Johan</creator><creator>Dixon, Mark</creator><creator>Ndebele, Wedu</creator><creator>Gunguwo, Hilary</creator><creator>Colebunders, Robert</creator><creator>Ndlovu, Mbongeni</creator><creator>Apollo, Tsitsi</creator><creator>Ferrand, Rashida A</creator><general>Copyright Wolters Kluwer Health, Inc. 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This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown.
OBJECTIVE:To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents.
METHODS:We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models.
RESULTS:Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively.
CONCLUSIONS:Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescentsʼ needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>28002183</pmid><doi>10.1097/QAI.0000000000001274</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of acquired immune deficiency syndromes (1999), 2017-04, Vol.74 (4), p.390-398 |
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| source | Journals@Ovid LWW Legacy Archive; Journals@Ovid Complete; Free E- Journals |
| subjects | AIDS/HIV Antiretroviral drugs Implementation Science Lentivirus Medical treatment Mortality Regression analysis Retention Retroviridae Teenagers |
| title | Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe |
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