Two-year retention in care for adolescents on antiretroviral therapy in Ehlanzeni district, South Africa: a baseline cohort analysis

Figures & data

Figure 1. Kaplan-Meier survival estimates for retention among adolescent over 2 years period.

Table 1. Retention in care at 6, 12, 18 and 24 months by demographic characteristics and clinical outcomes of 16,108 adolescents on ART in Ehlanzeni district, South Africa, 2019.

Month	Total	Retained in care
		6	12	18	24
Overall	16,108 (%)	14,567 (90.48)	13,746 (85.38)	13,011 (80.81)	12,274 (76.24)
Age (current)*
10–14 years	7,745 (48.11)	7,092 (91.57)	6,729 (86.88)	6,401 (82.65)	6,050 (78.11)
15–19 years	8,355 (51.89)	7,475 (89.47)	7,017 (83.99)	6,610 (79.11)	6,224 (74.49)
Gender*
Female	8,542 (53.06)	7,605 (89.03)	7,153 (83.74)	6,276 (83.04)	6,320 (73.99)
Male	7,558 (46.94)	6,962 (92.11)	6,593 (87.23)	6,735 (78.85)	5,954 (78.78)
Method into ART*
New	11,295 (70.19)	9,809 (86.84)	9,037 (80.01)	8,380 (74.19)	7,740 (68.53)
Previously on ART	4,796 (29.81)	4,752 (99.08)	4,703 (98.06)	4,625 (96.43)	4,529 (94.43)
Initiated on ART during pregnancy*
No	7,762 (93.54)	7,047 (90.79)	6,699 (86.31)	6,339 (81.67)	5,994 (77.22)
Yes	536 (6.46)	348 (64.93)	273 (50.93)	236 (44.03)	190 (35.45)
Age at ART start (in years)*
0–9	10,798 (67.07)	10,024 (92.83)	9,559 (88.53)	9,120 (84.46)	8,711 (80.67)
10–14	3,900 (24.23)	3,523 (90.33)	3,332 (85.44)	3,143 (80.59)	2,942 (75.44)
15–19	1,401 (8.70)	1,019 (72.73)	854 (60.96)	747 (53.32)	620 (44.25)
Initiated on Isoniazid Preventative Therapy (IPT)
No	13,954 (86.67)	12,628 (90.50)	11,905 (85.32)	11,261 (80.70)	10,613 (69.23)
Yes	2,146 (13.33)	1,939 (90.35)	1,841 (85.79)	1,750 (81.55)	1,661 (37.01)
History of TB*
No	12,296 (98.09)	11,513 (93.63)	11,108 (90.34)	10,746 (87.39)	10,333 (84.04)
Yes	239 (1.91)	160 (66.95)	144 (60.25)	131 (54.81)	118 (49.37)
CD4 count at baseline*
CD4 below 200	3,264 (32.57)	2,881 (88.27)	2,702 (82.78)	2,515 (77.05)	2,328 (71.32)
CD4 above 200	6,759 (67.43)	6,194 (91.64)	5,810 (85.96)	5,496 (81.31)	5,211 (77.10)
CD4 count at last visit*
CD4 below 200	2,226 (17.43)	1,871 (84.05)	1,734 (77.90)	1,609 (72.28)	1,486 (66.76)
CD4 above 200	10,546 (82.57)	10,016 (94.97)	9,583 (90.87)	9,158 (86.82)	8,722 (82.70)
WHO Stage at initiation*
1	5,471 (45.66)	4,916 (89.86)	4,655 (85.08)	4,444 (81.23)	4,176 (76.33)
2	3,113 (25.98)	2,878 (92.45)	2,745 (88.18)	2,608 (83.78)	2,473 (79.44)
3	2,872 (23.97)	2,574 (89.62)	2,444 (85.10)	2,324 (80.92)	2,218 (77.23)
4	525 (4.38)	465 (88.57)	438 (83.43)	425 (80.95)	402 (76.57)
Initiated same day
No	15,907 (99.03)	14,400 (90.53)	13,589 (85.43)	12,866 (80.88)	12,149 (76.38)
Yes	156 (0.97)	136 (87.18)	128 (82.05)	117 (75.00)	102 (65.38)
Second line regimen*
No	14,113 (87.66)	12,598 (89.27)	11,790 (83.54)	11,068 (78.42)	10,362 (58.40)
Yes	1,987 (12.34)	1,969 (99.09)	1,956 (98.44)	1,943 (97.79)	1,912 (92.06)
Viral suppression (<1000) *
No	4,113 (30.85)	3,919 (95.28)	3,774 (91.76)	3,610 (87.77)	3,432 (83.44)
Yes	9,220 (69.15)	9,167 (99.43)	8,897 (96.50)	8,561 (92.85)	8,172 (88.63)

Figure 2. Kaplan-Meier survival estimates for retention among younger adolescent (10-14 years) compared to older adolescents (15-19 years) over 2 years period.

Figure 3. Kaplan-Meier survival estimates for retention among adolescent males compared to females over 2 years period.

Table 2. Cox proportional hazard analysis of factors associated with retention in care over 24 months among adolescents on ART in Ehlanzeni district, South Africa (N = 16,108).

	Total (N = 16,108)		Female (n = 8,542)		Male (n = 7,558)
	crude HR (95% CI)	aHR (95% CI)	crude HR (95% CI)	aHR (95% CI)	crude HR (95% CI)	aHR (95% CI)
Age
10–14	1*	1	1*	1	1*	1
15–19	1.44 (1.35-1.55)	0.97(0.79-1.19)	1.68 (1.53-1.85)	1.19 (0.84-1.51)	1.19 (1.07-1.32)	0.74 (0.55-1.00)
Gender
Male	1*	1*
Female	1.19 (1.11-1.27)	1.28 (1.10-1.49)		–		–
Method into ART
Transferred in	1*	1*	1*	1*	1*	1*
New	2.61 (2.40-2.84)	1.83 (1.48-2.27)	2.71 (2.42-3.04)	1.71 (1.28-2.27)	2.48 (2.19-2.81)	1.91 (1.39-2.63)
Initiated on ART during pregnancy
No	1*		1*	1*
Yes	4.53 (3.93-5.23)		4.52 (3.92-5.22)	2.72 (1.99-3.69)
Initiated on IPT
No	1	1	1*	1	1*	1
Yes	0.97 (0.88-1.08)	0.95 (0.79-1.13)	1.18 (1.04-1.34)	0.95 (0.76-1.18)	0.66 (0.54-0.80)	0.82 (0.59-1.12)
History of TB
No	1*	1*	1*	1	1*	1*
Yes	2.64 (2.04-3.43)	1.71 (1.10-2.65)	2.38 (1.66-3.39)	1.69 (0.92-3.12)	3.07 (2.10-4.48)	2.15 (1.13-4.09)
WHO stage
Stage 1	1	1	1*	1	1*	1
Stage 2	1.03 (0.93-1.14)	0.97 (0.81-1.16)	0.81 (0.70-0.92)	0.94 (0.73-1.21)	1.47 (1.26-1.72)	1.16 (0.87-1.54)
Stage 3	1.13 (1.02-1.25)	1.05 (0.87-1.28)	0.94 (0.82-1.07)	1.12 (0.86-1.45)	1.53 (1.31-1.79)	1.11 (0.82-1.49)
Stage 4	1.00 (0.82-1.22)	1.05 (0.70-1.56)	0.77 (0.58-1.03)	1.07 (0.62-1.86)	1.46 (1.09-1.94)	1.27 (0.71-2.29)
ART initiation on same day
No	1	1	1	1	1
Yes	1.03 (0.68-1.56)	0.87 (0.47-1.59)	0.79 (0.51-1.23)	1.19 (0.62-2.26)	2.80 (0.90-8.69)
Age at art start
0-9 years	1*	1*	1*	1*	1*	1*
10–14 years	1.69 (1.56-1.85)	2.45 (1.96-3.05)	1.77 (1.58-1.99)	2.38 (1.75-3.23)	1.62 (1.44-1.83)	2.49 (1.81-3.45)
15–19 years	5.06 (4.56-5.63)	9.67 (7.25-12.89)	5.75 (5.08-6.52)	7.39 (5.03-10.85)	3.09 (2.38-3.99)	6.73 (3.84-11.80)
CD4 count at last visit
CD4 < 200	1*	1*	1*	1*	1*	1*
CD4 > 200	0.42 (0.39-0.46)	0.66 (0.54-0.80)	0.45 (0.39-0.51)	0.67 (0.51-0.87)	0.38 (0.33-0.43)	0.58 (0.43-0.77)
CD4 count at baseline
CD4 < 200	1*	1	1*	1	1*	1*
CD4 > 200	0.73 (0.67-0.79)	0.94 (0.79-1.12)	0.80 (0.71-0.90)	1.05 (0.83-1.32)	0.65 (0.57-0.73)	0.76 (0.58-0.98)
Second line
No	1*	1*	1*	1*	1*	1*
Yes	0.32 (0.27-0.37)	0.38 (0.29-0.50)	0.32 (0.26-0.39)	0.36 (0.25-0.52)	0.32 (0.26-0.39)	0.39 (0.27-0.56)
Viral load <1000
No	1*	1*	1*	1*	1*	1*
Yes	0.40 (0.37-0.44)	0.30 (0.26-0.35)	0.43 (0.39-0.48)	0.34 (0.0.28-0.42)	0.35 (0.31-0.40)	0.23 (0.17-0.29)