Introduction: High levels of adherence to antiretroviral therapy (ART) and retention in
treatment programs are required for successful virologic suppression and treatment outcomes. While
there have been numerous studies focusing on adherence and loss to follow-up (LTFU) in adults,
studies in children and young adolescents are limited. For this study, we examined patterns of
adherence and LTFU in HIV-infected pediatric patients receiving ART in PEPFAR-funded sites in
Methods: We conducted a retrospective observational study utilizing data that had been collected
during the course of care in a large pediatric ART program in Nigeria.
Results: A total of 3,513 children ages 0-14.9 years enrolled at 31 different sites between June 2005 and March 2011 were
included in the study. Of the enrolled patients, 1,987 (56%) were LTFU by the end of the study period. LTFU was highest
in those ages<2 years and those ≥13 years (versus aged 2-12.9 years). Year of ART initiation was a strong predictor of
LTFU across all age groups. For those patients retained to 12 months, less than half showed optimal adherence (≥95%).
While there were no differences in adherence rates at month 12 by age group, those aged 10 years and older did have
declining adherence starting at 18 months.
Discussion: Adherence is critical for optimal ART patient outcomes. We found both low adherence and high LTFU rates
in our study cohort. Additional studies focused on barriers to adherence and development of age-specific intervention
programs are critical to improving overall pediatric outcomes.