Abstract:
Background
Retention, defined as continuous engagement in care, is an important indicator for quality of
healthcare services. To achieve UNAIDS 90-90-90 targets, emphasis on retention as a pre dictor of viral suppression in patients initiated on ART is vital. Using routinely collected clini cal data, the authors sought to determine the effect of age on retention post ART initiation.
Methods
De-identified electronic data for 32965 HIV-infected persons aged 15 years at enrolment
into the Academic Model Providing Access to Healthcare program between January 2008
and December 2014 were analyzed. Follow-up time was defined from the date of ART initia tion until either loss to follow-up or death or close of the database (September 2016) was
observed. Proportions were compared using Pearson’s Chi-square test and medians using
Mann-Whitney U test. Logistic regression model was used to assess differences in ART initi ation between groups, adjusting for baseline characteristics. Cox proportional hazards
model adjusting for baseline characteristics and antiretroviral therapy (ART) status was
used to compute hazard ratios. Kaplan-Meier survival function was used to compare reten tion on ART at 12, 24, and 36 months post ART initiation.
Results
Of the total sample, 3924 (12.0%) were aged 50 years at enrolment. The median (IQR)
age of young adults and older adults were 32.5 (26.6, 36.9) and 54.9 (51.7, 59.9) respec tively. ART initiation rates were 70.5% among older adults and 68.2% among younger
adults. Retention rates in care at 12, 24 and 36 months post ART initiation were 73.9% (95%
CL: 72.2, 75.5), 62.9% (95% CL: 61.0, 64.7) and 55.4% (95% CL: 53.5, 57.3) among older
adults compared to 69.8% (95% CL: 69.1, 70.4), 58.1% (95% CL: 57.4, 58.8) and 49.3%(95% CL: 48.6, 50.0) among younger adults (p <0.001). A higher proportion of older adults
were retained in HIV care post ART initiation compared to younger adults, Adjusted Hazard
Ratio (AHR): 0.83 (95% CI: 0.78, 0.87) though they were more likely to die, AHR: 1.35 (95%
CI: 1.19, 1.52).
Conclusion
A higher proportion of older adults are initiated on ART and have better retention in care at 12,
24 and 36 months post ART initiation than younger adults. However, older adults have a
higher all-cause mortality rate, perhaps partially driven by late presentation to care. Enhanced
outreach and care to this group is imperative to improve their outcomes.
