Background:
Continuity of treatment for people living with HIV is paramount in order to achieve the UNAIDS 95-95-95 targets and reach epidemic control. Treatment disengagement is linked to increases in viral load and onward HIV transmission. To better understand continuity of treatment, we analyzed treatment interruption patterns among children, adolescents, and young adults in USAID-supported PEPFAR countries.
Methods:
Routinely collected programmatic data from 42 USAID-supported PEPFAR country and regional programs were analyzed for U.S. fiscal year (FY) 2022 Quarter(Q) 3 through FY2023 Q2 (April 2022 – March 2023). We compared trends in the percent and volume of interruptions in treatment (IIT; overall, <3 months on treatment, 3-5 months on treatment, and 6+ months on treatment) among children (0-9 years), adolescents (10-19 years), and young adults (20-29 years). Interruption in treatment is defined as no clinical contact for 28 days after the last expected clinical appointment or medication pick-up date.
Results:
Comparing FY22Q3 to FY23Q2, the overall %IIT as well as absolute number of IIT decreased for all age groups: children (2.8% vs 2.6%; 3,613 vs 3,303), adolescents (2.8% vs 2.6%; 8,141 vs 7,853), and young adults (3.5% vs 3.4%; 44,721 vs 37,435); however, a peak in %IIT was observed for all ages in FY23Q1 (3.2%, 3.1% and 4.1%, respectively). Though overall %IIT is highest for young adults in all quarters, in FY22Q4 through FY23Q2 the highest rates of %IIT occurred in adolescents who have been on treatment for <3 months (12.1%, 14.9% and 11.9%) followed by adolescents who have been on treatment for 3-5 months (11.2%, 12,7% and 8.0%). %IIT among those who have been on treatment for 6+ months is greatest for young adults across all four quarters. For all age groups between FY22Q4 and FY23Q2, the absolute number of IIT is largest at 6+ months, however, compared to overall %IIT, higher rates of % IIT are observed within the first three months on treatment (ranging from 2.7 - 4.8 times more often) followed by 3-5 months (ranging from 2.1 - 4.8 times more often).
Conclusions:
Overall rates of IIT among children, adolescents, and young adults in USAID-supported PEPFAR programs between FY22Q3 and FY23Q2 remain high. The pattern of markedly high rates of IIT in individuals, particularly adolescents, on treatment <3 months and 3-5 months, highlights the need for targeted interventions and support for new initiators to ensure continuity of treatment.