Sociobehavioral determinants of non-retention among adolescents and young adults living with HIV.

Abstract

Objective: This study aimed to identify age-specific cofactors of nonretention among adolescents and young adults living with HIV (AYLHIV) ages 10-24.

Design: This analysis used data from the Data-Informed Stepped Care study (DiSC; NCT05007717), a cluster randomized clinical trial in 24 health facilities in Western Kenya.

Methods: During 12-month follow-up, youth-reported cofactors of missed visits and loss-to-follow-up (LTFU; did not return to clinic within study period) were assessed using generalized linear and mixed effect models and stratified by gender and age.

Results: Among 1904 AYLHIV, median age was 17 years (interquartile range 14-19), and 57.9% were female. A higher proportion of missed visits was observed in older ages (10-14: 6.0%; 15-19: 7.9%; 20-24: 12.5%). Overall, higher resilience (PR = 0.93) and satisfaction with clinic (PR = 0.81) were associated with lower risk of missed visits. Among males, satisfaction with clinic was associated with lower risk (PR = 0.61) while higher stigma was associated with increased risk (PR = 1.31). Among females, resilience was associated with lower risk (PR = 0.93). Having no living parents was associated with higher LTFU risk (PR = 2.24). Among males, horizontal transmission was associated with higher risk (PR = 2.98) and resilience with lower risk (PR = 0.76). Females who came to clinic alone had lower risk of LTFU (PR = 0.27). Age-stratified analyses did not identify additional cofactors.

Conclusions: In this large multisite cohort, older AYLHIV had the most retention challenges. Resilience, satisfaction with clinical care, and stigma exerted an influential role, but cofactors differed between age and gender strata, underscoring the heterogeneity of AYLHIV and suggesting need for tailored approaches.