Can an adolescent HIV psychosocial attrition risk assessment tool predict lost to follow up? Preliminary findings from Uganda

Title

Can an adolescent HIV psychosocial attrition risk assessment tool predict lost to follow up? Preliminary findings from Uganda

Presenter

Naomi Medina-Jaudes

Authors

N. Medina-Jaudes * (1), D. Adoa (2), N. Aziz (3), K.J. Bosco (3), A. Carmone (1), S. Dowling (1), J. Joseph (1), E. Magongo Namusoke (3), K. Mary (3), M. Mbabazi (3), V. Nabitaka (2), B. Namayanja (3), K. Suggu (1), A. Williams (1), A. Musoke (2), T. Nabwire Chimulwa (3)

Institutions

(1) Clinton Health Access Initiative, Inc., Boston, United States, (2) Clinton Health Access Initiative, Inc., Kampala, Uganda, (3) Ministry of Health, Uganda, Kampala, Uganda

BACKGROUND: Retention in HIV care impacts medication adherence and viral suppression, and factors influencing attrition from HIV care are multifactorial for adolescents. To help identify adolescents at risk for loss-to-follow-up (LTFU) and more effectively target interventions to improve retention and viral load (VL) suppression, we are developing and evaluating an adolescent psychosocial attrition risk assessment (APARA) tool for predicting attrition from HIV care among adolescents in Uganda.
METHODS: The APARA tool will be implemented from November 2021 through July 2022. 20 facilities were randomly selected for implementation, stratifying by region and urban/rural designation. Adolescents living with HIV, aged 15-19 years, who are currently on antiretroviral therapy (ART) and active in care at the facility are eligible for enrollment. Healthcare workers will administer the APARA tool at enrollment and each standard-of-care visit for 6 months. Patient data such as ART visit dates and most recent viral load are extracted from study participants' medical records. While LTFU status can't yet be analyzed, a stepwise backwards multivariate model was used to determine preliminary predictors of unsuppressed VL.
RESULTS: By December 2021, 461 adolescents had been enrolled. Participants were on ART for an average of nine years; about 10% were on ART for less than one year. Of the 424 participants with VL results, 92% were virally suppressed. An adolescent was more likely to be unsuppressed if they were initiated on ART at an advanced stage of HIV (Odds Ratio (OR): 11.13), on second line treatment (OR: 6.04), had fair or poor adherence (OR: 7.39), or if they had missed any of their previous three appointments (OR: 4.65). An adolescent was more likely to be suppressed if they received an ARV refill for 60 or more days (OR: 0.07).
CONCLUSIONS: Early results have shown what risk factors are associated with unsuppressed VL. The study's final analysis will assess whether scoring the APARA tool and finding a specific cut-off point can accurately predict participants' LTFU status. The tool is expected to assist the program in identifying adolescents at risk of attrition early-on so appropriate or extra support can be provided to minimize LTFU.

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