Treatment failure in adolescents and young people living with HIV: a cohort study.
Camila Moraes Garollo Piran, Alana Vitória Escritori Cargnin, Mariana Martire Mori and 5 others
PMID 42339939WHAT IT FOUND
Of 512 adolescents and young people with HIV, 160 had poor adherence and 197 were lost to follow-up.
Missed appointments, delayed ART, a sexual partner, and drug use were linked to these failures.
Key findings
01Of 512 eligible adolescents and young people living with HIV, 155 were adherent, 160 had poor adherence, and 197 were lost to follow-up.
02In the adjusted model, poor adherence was associated with having a sexual partner (relative risk 1.26), starting ART 50 to 100 days after diagnosis (1.27), starting ART more than 100 days after diagnosis (1.45), and missing appointments (1.52); being aged 20 to 24 years was associated with lower poor adherence (0.77).
03In the adjusted model, loss to follow-up was associated with drug use (relative risk 1.25), efavirenz-based ART (1.46), other ART regimens (1.63), starting ART more than 100 days after diagnosis (1.46), and missing appointments (1.84); alcohol use was associated with lower loss to follow-up (0.80).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used one outpatient clinic in Paraná, Brazil, so results may not apply to clinics with different populations or systems. Data came from routine medical and medication dispensing records, so completeness depends on how well staff recorded appointments and medication pickup. Variables with missing information were excluded from the regression models, which may leave some patients unrepresented in the adjusted results. The design was observational, so associated factors are not proven causes. The sample was consecutive but non-probabilistic.
Declared interests
No conflicts of interest were reported. The study was supported by CAPES, Brazil, Funding Code 001.
The easy way to misread this
Do not conclude that delayed ART, sexual partnership, drug use, or missed appointments caused poor adherence or loss to follow-up. This was an observational record-based cohort from one clinic, so other unmeasured factors may explain the associations.