Article Text
Abstract
Introduction Substantial disparities in care outcomes exist between different subgroups of adolescents and youths living with HIV (AYLHIV). Understanding variation in individual and health facility characteristics could be key to identifying targets for interventions to reduce these disparities. We modelled variation in AYLHIV retention in care and viral suppression, and quantified the extent to which individual and facility characteristics account for observed variations.
Methods We included 1170 young adolescents (10–14 years), 3206 older adolescents (15–19 years) and 9151 young adults (20–24 years) who were initiated on antiretroviral therapy (ART) between January 2015 and December 2017 across 124 healthcare facilities in Nigeria. For each age group, we used multilevel modelling to partition observed variation of main outcomes (retention in care and viral suppression at 12 months after ART initiation) by individual (level one) and health facility (level two) characteristics. We used multiple group analysis to compare the effects of individual and facility characteristics across age groups.
Results Facility characteristics explained most of the observed variance in retention in care in all the age groups, with smaller contributions from individual-level characteristics (14%–22.22% vs 0%–3.84%). For viral suppression, facility characteristics accounted for a higher proportion of variance in young adolescents (15.79%), but not in older adolescents (0%) and young adults (3.45%). Males were more likely to not be retained in care (adjusted OR (aOR)=1.28; p<0.001 young adults) and less likely to achieve viral suppression (aOR=0.69; p<0.05 older adolescent). Increasing facility-level viral load testing reduced the likelihood of non-retention in care, while baseline regimen TDF/3TC/EFV or NVP increased the likelihood of viral suppression.
Conclusions Differences in characteristics of healthcare facilities accounted for observed disparities in retention in care and, to a lesser extent, disparities in viral suppression. An optimal combination of individual and health services approaches is, therefore, necessary to reduce disparities in the health and well-being of AYLHIV.
- HIV
- public health
- health services research
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Footnotes
Handling editor Sanni Yaya
Twitter @badejokikiolu
Contributors OB conceived the study, conducted the analysis and wrote all drafts of the manuscript. All authors provided critical reviews of the drafts. All authors read and approved of the final draft.
Funding The data on which this study is based are from a project funded by the US Presidents Emergency Plan for AIDS (PEPFAR), awarded through the Centre for Disease Control. OB received doctoral research funding from the Belgium Directorate-General for Development Cooperation (DGD) awarded through the Institute of Tropical Medicine Antwerp, Belgium.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Ethical approval for this study was obtained from the IRBs of APIN and the Institute of Tropical Medicine, Antwerp.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data not publicly available but may be obtained upon request and approval from APIN-PEPFAR clinical data repository.