{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:07:58Z","timestamp":1740146878811,"version":"3.37.3"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T00:00:00Z","timestamp":1688083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG3 HD096906"],"award-info":[{"award-number":["UG3 HD096906"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007813","name":"Center for AIDS Research, University of Washington","doi-asserted-by":"publisher","award":["P30 AI027757"],"award-info":[{"award-number":["P30 AI027757"]}],"id":[{"id":"10.13039\/100007813","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Loss to follow-up (LTFU) among adolescents and young adults living with HIV (AYALWH) is a barrier to optimal health and HIV services. We developed and validated a clinical prediction tool to identify AYALWH at risk of LTFU.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used electronic medical records (EMR) of AYALWH ages 10 to 24 in HIV care at 6 facilities in Kenya and surveys from a subset of participants. Early LTFU was defined as &gt;30 days late for a scheduled visit in the last 6 months, which accounts for clients with multi-month refills. We developed a tool combining surveys with EMR (\u2018survey-plus-EMR tool\u2019), and an \u2018EMR-alone\u2019 tool to predict high, medium, and low risk of LTFU. The survey-plus-EMR tool included candidate sociodemographics, partnership status, mental health, peer support, any unmet clinic needs, WHO stage, and time in care variables for tool development, while the EMR-alone included clinical and time in care variables only. Tools were developed in a 50% random sample of the data and internally validated using 10-fold cross-validation of the full sample. Tool performance was evaluated using Hazard Ratios (HR), 95% Confidence Intervals (CI), and area under the curve (AUC) \u2265 0.7 for good performance and \u22650.60 for modest performance.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Data from 865 AYALWH were included in the survey-plus-EMR tool and early LTFU was (19.2%, 166\/865). The survey-plus-EMR tool ranged from 0 to 4, including PHQ-9 \u22655, lack of peer support group attendance, and any unmet clinical need. High (3 or 4) and medium (2) prediction scores were associated with greater risk of LTFU (high, 29.0%, HR 2.16, 95%CI: 1.25\u20133.73; medium, 21.4%, HR 1.52, 95%CI: 0.93\u20132.49, global p-value = 0.02) in the validation dataset. The 10-fold cross validation AUC was 0.66 (95%CI: 0.63\u20130.72). Data from 2,696 AYALWH were included in the EMR-alone tool and early LTFU was 28.6% (770\/2,696). In the validation dataset, high (score = 2, LTFU = 38.5%, HR 2.40, 95%CI: 1.17\u20134.96) and medium scores (1, 29.6%, HR 1.65, 95%CI: 1.00\u20132.72) predicted significantly higher LTFU than low-risk scores (0, 22.0%, global p-value = 0.03). Ten-fold cross-validation AUC was 0.61 (95%CI: 0.59\u20130.64).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Clinical prediction of LTFU was modest using the surveys-plus-EMR tool and the EMR-alone tool, suggesting limited use in routine care. However, findings may inform future prediction tools and intervention targets to reduce LTFU among AYALWH.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0286240","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T17:32:25Z","timestamp":1688146345000},"page":"e0286240","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and validation of a prediction tool to support engagement in HIV care among young people ages 10\u201324 years in Kenya"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1233-5724","authenticated-orcid":true,"given":"Kate","family":"Wilson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kawango","family":"Agot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Dyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacinta","family":"Badia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Kibugi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Risper","family":"Bosire","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1166-0760","authenticated-orcid":true,"given":"Jillian","family":"Neary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Inwani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Beima-Sofie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema","family":"Shah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nahida","family":"Chakhtoura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"John-Stewart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Kohler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,6,30]]},"reference":[{"article-title":"SEIZING THE MOMENT: GLOBAL AIDS UPDATE 2020","year":"2020","author":"UNAIDS.","key":"pone.0286240.ref001"},{"key":"pone.0286240.ref002","doi-asserted-by":"crossref","first-page":"e25215","DOI":"10.1002\/jia2.25215","article-title":"Mortality and losses to follow-up among adolescents living with HIV in the IeDEA global cohort collaboration","volume":"21","author":"A Kariminia","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"pone.0286240.ref003","doi-asserted-by":"crossref","first-page":"e000004","DOI":"10.1136\/bmjgh-2015-000004","article-title":"Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave","volume":"1","author":"BC Zanoni","year":"2016","journal-title":"BMJ Glob Health"},{"key":"pone.0286240.ref004","doi-asserted-by":"crossref","first-page":"e85774","DOI":"10.1371\/journal.pone.0085774","article-title":"Determinants of mortality and loss to follow-up among adults enrolled in HIV care services in Rwanda.","volume":"9","author":"V Mugisha","year":"2014","journal-title":"PLoS One"},{"journal-title":"Kenya HIV County Profiles. 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