Predicting lost to follow-up status using an adolescent HIV psychosocial attrition risk assessment tool: Results from a mixed methods prospective cohort study in Uganda

J Acquir Immune Defic Syndr. 2024 Jan 2. doi: 10.1097/QAI.0000000000003381. Online ahead of print.


BACKGROUND: Low retention in care for adolescents living with HIV (ALHIV) has been a key driver of sub-optimal viral load suppression rates in Uganda. The objective of the study was to develop a psychosocial risk assessment tool and evaluate its ability to predict risk of attrition of ALHIV between the ages of 15 and 19.

SETTING: The study was conducted in 20 facilities in Central and Western Uganda from August 2021 through July 2022.

METHODS: A mixed methods prospective cohort study was conducted in two phases. In the first phase, the Adolescent Psychosocial Attrition Risk Assessment (APARA) tool was developed and revised using feedback from focus group discussions and interviews. In the second phase, the ability of the APARA tool to predict attrition among ALHIV was evaluated using diagnostic accuracy tests.

RESULTS: A total of 597 adolescents between the ages of 15 and 19 were enrolled, of which 6% were lost-to-follow-up (LTFU) at the end of the study period. A 20-question tool was developed, with 12 questions being responded to affirmatively by more than 50% of all participants. Using a cut-off score of six or more affirmative answers translated to an area under the curve of 0.58 (95% CI: 0.49-0.66), sensitivity of 55% (95% CI: 36-72%) and specificity of 61% (95% CI: 56-65%).

CONCLUSION: While the APARA tool was not effective at predicting LTFU status among ALHIV, the tool was useful for identifying psychosocial issues experienced by ALHIV and may be appropriate to administer during routine care visits to guide action.

PMID:38180899 | DOI:10.1097/QAI.0000000000003381