Magreth Thadei Mwakilasa, Maryam Amour, Suleiman Chombo, Joan Rugemalila, Emmanuel Balandya, Blandina T Mmbaga, Lameck Machumi, Angelica Rugarabamu, Michael Johnson Mahande, David Sando, Bruno F Sunguya
{"title":"2015-2019年坦桑尼亚达累斯萨拉姆地区感染艾滋病毒的青少年和青壮年接受抗逆转录病毒治疗后随访损失预测因素的回顾性队列研究","authors":"Magreth Thadei Mwakilasa, Maryam Amour, Suleiman Chombo, Joan Rugemalila, Emmanuel Balandya, Blandina T Mmbaga, Lameck Machumi, Angelica Rugarabamu, Michael Johnson Mahande, David Sando, Bruno F Sunguya","doi":"10.1186/s12879-025-11157-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In Tanzania, loss to follow-up (LTFU) among adolescents and young adults living with HIV (AYLHIV) presents a significant challenge. A retrospective cohort study analysing data found that approximately 42% of adolescents on antiretroviral therapy (ART) were LTFU between 2014 to 2016. This study examined the predictors of LTFU among AYLHIV in Dar es Salaam during their first year of ART treatment.</p><p><strong>Methods: </strong>This retrospective cohort study utilized routine data collected in care and treatment centres among adolescents and young adults aged 10-24 years living with HIV in Dar es Salaam who were enrolled in HIV care from 2015-2019. The data were analysed using STATA 14. Descriptive statistics were summarized using frequencies and proportions. Kaplan-Meier method was used to determine failure probabilities within one year of ART initiation. The Fine and Gray test was conducted to report adjusted sub-hazard ratios (aSHRs) and cumulative incidence estimates for LTFU within one year of ART initiation, accounting for mortality as a competing risk.</p><p><strong>Results: </strong>A total of 15,874 AYLHIVs enrolled in Care and Treatment Clinics between 2015 and 2019 were studied. The majority (10,913, 68.7%) were young adults, and 13,160 (84.4%) were female. The percentage of LTFUs within one year of ART initiation was 15%. The significant predictors of LTFU were age 20-24 years, having a CD4 cell count between 350 and 499, receiving care in healthcare facilities located in the Ubungo district and being enrolled in care between 2018 and 2019. Receiving care at private healthcare facilities, having a tuberculosis co-infection, and being classified as WHO Stage III were all associated with a reduced risk of LTFU in ART care.</p><p><strong>Conclusion: </strong>This study found that adolescents and young people in Tanzania experience 15% rates of LTFU in ART care, within one year of ART initiation. Therefore, HIV service providers need to pay particular attention to the AYLHIV and factors that influence LTFU in ART care. The increasing incidence of LTFU necessitates the implementation of effective and friendly tracing interventions to identify AYLHIV patients who have become LTFU to re-engage them in care.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"25 1","pages":"852"},"PeriodicalIF":3.4000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219877/pdf/","citationCount":"0","resultStr":"{\"title\":\"Retrospective cohort study of predictors of loss to follow up among adolescents and young adults living with HIV on ART in Dar es Salaam, Tanzania, 2015-2019.\",\"authors\":\"Magreth Thadei Mwakilasa, Maryam Amour, Suleiman Chombo, Joan Rugemalila, Emmanuel Balandya, Blandina T Mmbaga, Lameck Machumi, Angelica Rugarabamu, Michael Johnson Mahande, David Sando, Bruno F Sunguya\",\"doi\":\"10.1186/s12879-025-11157-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In Tanzania, loss to follow-up (LTFU) among adolescents and young adults living with HIV (AYLHIV) presents a significant challenge. A retrospective cohort study analysing data found that approximately 42% of adolescents on antiretroviral therapy (ART) were LTFU between 2014 to 2016. This study examined the predictors of LTFU among AYLHIV in Dar es Salaam during their first year of ART treatment.</p><p><strong>Methods: </strong>This retrospective cohort study utilized routine data collected in care and treatment centres among adolescents and young adults aged 10-24 years living with HIV in Dar es Salaam who were enrolled in HIV care from 2015-2019. The data were analysed using STATA 14. Descriptive statistics were summarized using frequencies and proportions. Kaplan-Meier method was used to determine failure probabilities within one year of ART initiation. The Fine and Gray test was conducted to report adjusted sub-hazard ratios (aSHRs) and cumulative incidence estimates for LTFU within one year of ART initiation, accounting for mortality as a competing risk.</p><p><strong>Results: </strong>A total of 15,874 AYLHIVs enrolled in Care and Treatment Clinics between 2015 and 2019 were studied. The majority (10,913, 68.7%) were young adults, and 13,160 (84.4%) were female. The percentage of LTFUs within one year of ART initiation was 15%. The significant predictors of LTFU were age 20-24 years, having a CD4 cell count between 350 and 499, receiving care in healthcare facilities located in the Ubungo district and being enrolled in care between 2018 and 2019. 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引用次数: 0
摘要
背景：在坦桑尼亚，感染艾滋病毒（AYLHIV）的青少年和年轻成人的随访损失（LTFU）提出了一个重大挑战。一项回顾性队列研究分析数据发现，在2014年至2016年期间，接受抗逆转录病毒治疗（ART）的青少年中约有42%是LTFU。这项研究检查了达累斯萨拉姆的AYLHIV患者在抗逆转录病毒治疗的第一年中LTFU的预测因素。方法：本回顾性队列研究利用在达累斯萨拉姆护理和治疗中心收集的常规数据，这些数据来自2015-2019年参加艾滋病毒护理的10-24岁艾滋病毒感染青少年和年轻人。使用STATA 14对数据进行分析。描述性统计使用频率和比例进行汇总。Kaplan-Meier方法用于确定ART启动一年内的失效概率。进行Fine and Gray试验，报告抗逆转录病毒治疗开始后一年内LTFU的调整亚危险比（aSHRs）和累积发病率估计值，并将死亡率作为竞争风险考虑在内。结果：2015年至2019年期间，共有15874名aylhiv患者在护理和治疗诊所登记。其中以青壮年居多（10913人，68.7%），女性13160人（84.4%）。开始抗逆转录病毒治疗一年内ltfu的百分比为15%。LTFU的重要预测因素是年龄在20-24岁之间，CD4细胞计数在350 - 499之间，在位于优戈区的医疗机构接受治疗，并在2018年至2019年期间接受治疗。在私人卫生保健机构接受治疗、合并结核病感染以及被列为世卫组织第三阶段均与抗逆转录病毒治疗中LTFU风险降低有关。结论：本研究发现，坦桑尼亚的青少年和年轻人在开始抗逆转录病毒治疗的一年内，接受抗逆转录病毒治疗的LTFU率为15%。因此，艾滋病毒服务提供者需要特别关注抗逆转录病毒治疗中的AYLHIV和影响LTFU的因素。LTFU的发病率不断上升，需要实施有效和友好的追踪干预措施，以识别已成为LTFU的AYLHIV患者，并使其重新接受治疗。
Retrospective cohort study of predictors of loss to follow up among adolescents and young adults living with HIV on ART in Dar es Salaam, Tanzania, 2015-2019.
Background: In Tanzania, loss to follow-up (LTFU) among adolescents and young adults living with HIV (AYLHIV) presents a significant challenge. A retrospective cohort study analysing data found that approximately 42% of adolescents on antiretroviral therapy (ART) were LTFU between 2014 to 2016. This study examined the predictors of LTFU among AYLHIV in Dar es Salaam during their first year of ART treatment.
Methods: This retrospective cohort study utilized routine data collected in care and treatment centres among adolescents and young adults aged 10-24 years living with HIV in Dar es Salaam who were enrolled in HIV care from 2015-2019. The data were analysed using STATA 14. Descriptive statistics were summarized using frequencies and proportions. Kaplan-Meier method was used to determine failure probabilities within one year of ART initiation. The Fine and Gray test was conducted to report adjusted sub-hazard ratios (aSHRs) and cumulative incidence estimates for LTFU within one year of ART initiation, accounting for mortality as a competing risk.
Results: A total of 15,874 AYLHIVs enrolled in Care and Treatment Clinics between 2015 and 2019 were studied. The majority (10,913, 68.7%) were young adults, and 13,160 (84.4%) were female. The percentage of LTFUs within one year of ART initiation was 15%. The significant predictors of LTFU were age 20-24 years, having a CD4 cell count between 350 and 499, receiving care in healthcare facilities located in the Ubungo district and being enrolled in care between 2018 and 2019. Receiving care at private healthcare facilities, having a tuberculosis co-infection, and being classified as WHO Stage III were all associated with a reduced risk of LTFU in ART care.
Conclusion: This study found that adolescents and young people in Tanzania experience 15% rates of LTFU in ART care, within one year of ART initiation. Therefore, HIV service providers need to pay particular attention to the AYLHIV and factors that influence LTFU in ART care. The increasing incidence of LTFU necessitates the implementation of effective and friendly tracing interventions to identify AYLHIV patients who have become LTFU to re-engage them in care.
期刊介绍：
BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
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