Poor retention and care-related sex disparities among youth living with HIV in rural Mozambique
| Autor: | Wu Gong, C. William Wester, Anibal Naftal Fernando, Muktar H. Aliyu, Carolyn M. Audet, Magdalena Bravo, Sten H. Vermund, James G. Carlucci, Peter Memiah, Bryan E. Shepherd, Gael Claquin, Sara Van Rompaey, Aima A. Ahonkhai, Zhihong Yu, Melynda Simmons |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Male Rural Population RNA viruses Maternal Health Human immunodeficiency virus (HIV) HIV Infections medicine.disease_cause Logistic regression Pathology and Laboratory Medicine Adolescents Families 0302 clinical medicine Immunodeficiency Viruses Pregnancy Medicine and Health Sciences Public and Occupational Health 030212 general & internal medicine Young adult Children Mozambique Multidisciplinary Mortality rate Obstetrics and Gynecology Vaccination and Immunization Anti-Retroviral Agents Medical Microbiology Viral Pathogens Cohort Viruses Medicine Female Pathogens Research Article Adult Adolescent Anti-HIV Agents Death Rates Science Immunology Antiretroviral Therapy Microbiology Odds 03 medical and health sciences Young Adult Antiviral Therapy Population Metrics Retroviruses medicine Humans Lactation Adults Microbial Pathogens Proportional Hazards Models Retrospective Studies Health Care Policy Population Biology business.industry Lentivirus Organisms Biology and Life Sciences HIV Retrospective cohort study medicine.disease 030112 virology Health Care Young Adults Logistic Models Health Care Facilities Age Groups People and Places Women's Health Lost to Follow-Up Population Groupings Preventive Medicine business Demography |
| Zdroj: | PLoS ONE PLoS ONE, Vol 16, Iss 5, p e0250921 (2021) |
| ISSN: | 1932-6203 |
| Popis: | Background There are few studies that characterize sex-related differences in HIV outcomes among adolescents and young adults (AYA) 15–24 years of age. Methods We conducted a retrospective cohort study among AYA who enrolled in a comprehensive HIV program in Mozambique between 2012–2016. We assessed patients by sex and pregnancy/lactation status, comparing time to combination antiretroviral therapy (ART) initiation using Cox proportional hazard models. We employed multivariable logistic regression to investigate pre- and post-ART retention. Patients were defined as ‘retained pre-ART’ if they attended at least 3 of 4 required visits or started ART in the 6 months after enrollment, and ‘retained post-ART’ if they had any ART pickup or clinical visit during the last 90 days of the one-year follow-up period. Results Of 47,702 patients in the cohort, 81% (n = 38,511) were female and 19% (n = 9,191) were male. Of the females, 57% (n = 21,770) were non-pregnant and non-lactating (NPNL) and 43% (n = 16,741) were pregnant or lactating (PL). PL (aHR 2.64, 95%CI:2.47–2.81) and NPNL females (aHR 1.36, 95%CI:1.30–1.42) were more likely to initiate ART than males. PL females had higher odds of pre-ART retention in care (aOR 3.56, 95%CI: 3.30–3.84), as did NPNL females (aOR 1.71, 95%CI: 1.62–1.81), compared to males. This was also true for retention post-ART initiation, with higher odds for both PL (aOR 1.78, 95%CI:1.63–1.94) and NPNL females (aOR 1.50, 95%CI:1.35–1.65) compared to males. Conclusions PL females were most likely to initiate ART and remain in care post-ART in this AYA cohort, likely reflecting expansion of Option B+. Despite pregnancy and policy driven factors, we observed important sex-related disparities in this cohort. NPNL females were more likely to initiate ART and be retained in care before and after ART initiation than males. These data suggest that young males need targeted interventions to improve these important care continuum outcomes. |
| Databáze: | OpenAIRE |
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