HIV care interruptions during the first year of antiretroviral therapy among adolescents and young adults living with HIV aged 15-24 years in Khayelitsha, South Africa.

Background

Adolescents and young adults living with HIV (AYAHIV) aged 15-24 years experience poorer HIV outcomes than other age groups, with frequent interruptions from care. Interruptions during the first year of antiretroviral therapy (ART) are especially concerning, as they occur before sustained viral suppression. We estimated the incidence of early HIV care interruption and associated factors among AYAHIV initiating ART in the Khayelitsha cohort, Western Cape, South Africa.

Methods

We conducted a retrospective cohort study of AYAHIV initiating ART between 2017 and 2021. Early HIV care interruption was defined as ≥90 days late for a scheduled refill without documented death or transfer. Participants were followed for 12-15 months. Cox proportional hazards models assessed associated factors, adjusting for age, sex, calendar year, dispensing interval (single-month vs multi-month), and regimen among 2020-2021 initiators. A sensitivity analysis was restricted to those with ≥4 refills.

Results

Among 5,149 AYAHIV (85% female; median age 23 years), 44% experienced early interruption, most within six months. Initiation in 2020 (adjusted Hazard ratio (aHR): 1.10, 95% confidence interval (95% CI): 1.03, 1.17) and 2021 (aHR: 1.28 95% CI: 1.18, 1.39) was associated with increased interruption risk versus 2017-2019. Dolutegravir was associated with a reduced risk compared to efavirenz (aHR: 0.87 95% CI: 0.78, 0.97). In sensitivity analyses (n=3,013), 32% interrupted, with similar associations.

Conclusions

Early HIV care interruption was common, particularly during COVID-19. Dolutegravir was associated with improved retention, yet substantial early interruptions persisted, highlighting the need for intensified youth-focused support following ART initiation.