Adolescents living with HIV are struggling to stay in treatment
High treatment drop-out among adolescents living with HIV - with rates among those acquiring HIV in their teens nearly three times higher than those infected perinatally.
A new global analysis draws attention to the high rate of adolescents living with HIV who are dropping out of treatment. The study, published in the Journal of the International AIDS Society, analysed the records of more than 61,000 adolescents (aged 10-19) in 34 countries and found that 30% were lost to follow-up – meaning that they were no longer accessing life-saving treatment – during adolescence. The analysis also found 3.9% were reported to have died.
Globally, UNAIDS estimates that 1.8 million adolescents are living with HIV. Moreover, AIDS-related illness is the leading cause of death among young people (aged 10-24) in sub-Saharan Africa, and the second leading cause globally. A better understanding of the complex epidemic among this group is therefore essential for achieving the global targets for ending AIDS.
The analysis compared outcomes for individuals entering care before the age of 15 (used as a proxy for infection from mother-to-child) and those entering care after the age of 15 (used as a proxy for those infected during adolescence). The contrast between these groups was striking, with both loss to follow-up and incidences of mortality considerably higher in those infected later. Incidences of mortality were 3.9% versus 5.4%, while loss to follow-up was nearly three times higher among those infected later at 69% versus 26%.
Another noteworthy finding was that those entering care between age ten and 15 were at higher risk of death than those in care before age ten. This reflects the detrimental effects associated with late diagnoses.
The analysis reflects the complexity of the HIV epidemic among adolescents and highlights the persistent lack of targeted treatment programmes that effectively engage and retain young people in treatment. Greater prioritisation of adolescents for clinical and social support is urgently needed in order to close this gap in the HIV response.