Retention and Viral Suppression Among Adolescents Newly Initiating Antiretroviral Therapy in Adult HIV Care in Lima, Peru: A Retrospective Cohort Study.

PURPOSE: Published data on outcomes among adolescents newly initiating antiretroviral treatment in the Latin American context are sparse. We estimated the frequency of sustained retention with viral load suppression (i.e., successful transition) and identified predictors of successful transition into adult care among youth (aged 14-21 years) with recently acquired HIV in Lima, Peru. METHODS: A retrospective cohort study was conducted among 184 adolescents and young adults who initiated antiretroviral therapy in an adult public sector HIV clinic between June 2014 and June 2019. Sustained retention (no loss-to-follow-up or death) with viral suppression was calculated for the first 12 and 24 months following treatment initiation. We conducted regression analyses to assess factors associated with successful transition to adult HIV care, including gender, age, occupation, nationality, pregnancy, same-sex sexual behavior, presence of treatment supporter, number of living parents, and social risk factors that may adversely influence health (e.g., lack of social support, economic deprivation). RESULTS: Patients were predominantly male (n = 167, 90.8%). Median age was 19 years (interquartile range: 18-21). Frequency of sustained retention with viral load suppression was 42.4% (78/184) and 35.3% (30/85) at 12 and 24 months following treatment initiation. In multivariable analyses, working and/or studying was inversely associated with successful transition into adult care at 12 months; number of known living parents (relative risk: 2.20; 95% confidence interval: 1.12, 4.34) and absence of social risk factors (relative risk: 1.68; 95% confidence interval: 0.91, 3.11) were positively associated with successful transition at 24 months. DISCUSSION: Sustained retention in HIV care was uncommon. Parental support and interventions targeting social risk factors may contribute to successful transition into adult HIV care in this group.

Top and bottom longevity of nations: a retrospective analysis of the age-at-death distribution across 18 OECD countries.

BACKGROUND: Similar to the study of the distribution of income within countries, population-level health disparities can be examined by analyzing the distribution of age at death. METHODS: We sourced period-specific death counts for 18 OECD countries over 1900-2020 from the Human Mortality Database. We studied the evolution of country-year-specific distributions of age at death, with an examination of the lower and upper tails of these distributions. For each country-year, we extracted the 1st, 5th, 10th, 90th, 95th and 99th percentiles of the age-at-death distribution. We then computed the corresponding shares of longevity-the sum of the ages weighted by the age-at-death distribution as a fraction of the sum of the ages weighted by the distribution-for each percentile. For example, for the 10th percentile, this would correspond to how much longevity accrues to the bottom 10% of the age-at-death distribution in a given country-year. RESULTS: We expose a characterization of the age-at-death distribution across populations with a focus on the lower and upper tails of the distribution. Our metrics, specifically the gap measures in age and share across the 10th and 90th percentiles of the distribution, enable a systematic comparison of national performances, which yields information supplementary to the cross-country differences commonly pointed by traditional indicators of life expectancy and coefficient of variation. CONCLUSIONS: Examining the tails of age-at-death distributions can help characterize the comparative situations of the better- and worse-off individuals across nations, similarly to depictions of income distributions in economics.