{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T18:35:51Z","timestamp":1776191751175,"version":"3.50.1"},"reference-count":66,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T00:00:00Z","timestamp":1642204800000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Older adolescents aged 15\u201319 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non\u2010suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included adolescents aged 15\u201319 years initiating ART between 2004 and 2019, with \u2265 one viral load (VL) measurement between 4 and 24.5 months, and \u2265 6 months follow\u2010up, from six South African cohorts of the International epidemiology Databases to Evaluate AIDS\u2010Southern Africa (IeDEA\u2010SA). We defined VNS as VL \u2265400 copies\/ml and LTFU as not being in care for \u2265180 days from ART start and not known as transferred out of the clinic or dead in the first 24 months on ART. We examined factors associated with VNS and LTFU using Fine&amp;Gray competing risk models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included a total of 2733 adolescents, 415 (15.2%) males, median (IQR) age at ART start of 18.6 (17.3, 19.4) years. Among females, 585\/2318 (25.2%) were pregnant. Over the 24\u2010month follow\u2010up, 424 (15.5%) of all adolescents experienced VNS: range (11.1% pregnant females and 20.5% males). Over half of all adolescents were LTFU before any other event could occur. The hazard of VNS reduced with increasing age and CD4 count above 200 cells\/\u03bcl at ART initiation among all adolescents having adjusted for all measured patient characteristics [adjusted sub\u2010distribution hazard ratio (aSHR) 19 vs. 15 years: 0.50 (95% CI: 0.36, 0.68), aSHR: &gt;500 vs. \u2264200 cells\/\u03bcl: 0.22 (95% CI: 0.16, 0.31)]. The effect of CD4 count persisted in pregnant females. Increasing age and CD4 count &gt;200 cells\/\u03bcl were risk factors for LTFU among all adolescents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Older adolescents had a high risk of LTFU shortly after ART start and a low risk of VNS, especially those initiating treatment during pregnancy. Interventions addressing adherence and retention should be incorporated into adolescent\u2010friendly services to prevent VNS and LTFU and endeavour to trace lost adolescents as soon as they are identified.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25870","type":"journal-article","created":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T09:08:26Z","timestamp":1642237706000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Virologic non\u2010suppression and early loss to follow up among pregnant and non\u2010pregnant adolescents aged 15\u201319 years initiating antiretroviral therapy in South Africa: a retrospective cohort study"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-8500","authenticated-orcid":false,"given":"Patience","family":"Nyakato","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Schomaker","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine University of Cape Town  Cape Town South Africa"},{"name":"Institute of Public Health Medical Decision Making and Health Technology Assessment UMIT \u2010 University for Health Sciences Medical Informatics and Technology  Tyrol Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6467-662X","authenticated-orcid":false,"given":"Geoffrey","family":"Fatti","sequence":"additional","affiliation":[{"name":"Kheth'Impilo AIDS\u2010Free Living  Cape Town South Africa"},{"name":"Division of Epidemiology and Biostatistics Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Tanser","sequence":"additional","affiliation":[{"name":"Africa Centre for Health and Population Studies University of KwaZulu\u2010Natal  Somkhele South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Euvrard","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine University of Cape Town  Cape Town South Africa"},{"name":"Khayelitsha ART Programme and Medecins Sans Frontieres  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nosisa","family":"Sipambo","sequence":"additional","affiliation":[{"name":"Harriet Shezi Children's Clinic Chris Hani Baragwanath Academic Hospital  Soweto South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9887-0634","authenticated-orcid":false,"given":"Matthew P.","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health Boston University  Boston Massachusetts USA"},{"name":"Health Economics &amp; Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-181X","authenticated-orcid":false,"given":"Andreas D.","family":"Haas","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9014-3651","authenticated-orcid":false,"given":"Constantin T.","family":"Yiannoutsos","sequence":"additional","affiliation":[{"name":"Department of Biostatistics R.M. 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