{"doi":"10.1371/journal.pone.0286240","title":"Development and validation of a prediction tool to support engagement in HIV care among young people ages 10–24 years in Kenya","abstract":"INTRODUCTION: 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. METHODS: 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 >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 ('survey-plus-EMR tool'), and an 'EMR-alone' 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) ≥ 0.7 for good performance and ≥0.60 for modest performance. RESULTS: 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 ≥5, 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: 1.25-3.73; medium, 21.4%, HR 1.52, 95%CI: 0.93-2.49, global p-value = 0.02) in the validation dataset. The 10-fold cross validation AUC was 0.66 (95%CI: 0.63-0.72). 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: 1.17-4.96) and medium scores (1, 29.6%, HR 1.65, 95%CI: 1.00-2.72) 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: 0.59-0.64). CONCLUSIONS: 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.","journal":"PLoS ONE","year":2023,"id":368958,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9351,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":438003,"name":"Kawango Agot","orcid":"0000-0002-6153-8950","position":1,"is_corresponding":false},{"id":943112,"name":"Jessica Dyer","orcid":"0000-0003-0836-2316","position":2,"is_corresponding":false},{"id":888236,"name":"Jacinta Badia","orcid":"0000-0003-4376-8100","position":3,"is_corresponding":false},{"id":888825,"name":"James Kibugi","orcid":null,"position":4,"is_corresponding":false},{"id":712233,"name":"Risper Bosire","orcid":null,"position":5,"is_corresponding":false},{"id":507129,"name":"Jillian Neary","orcid":"0000-0003-1166-0760","position":6,"is_corresponding":false},{"id":376367,"name":"Irene Inwani","orcid":"0000-0002-4912-1028","position":7,"is_corresponding":false},{"id":507127,"name":"Kristin Beima‐Sofie","orcid":"0000-0002-3408-7410","position":8,"is_corresponding":false},{"id":337485,"name":"Seema Shah","orcid":"0000-0001-7726-1186","position":9,"is_corresponding":false},{"id":273033,"name":"Nahida Chakhtoura","orcid":null,"position":10,"is_corresponding":false},{"id":299048,"name":"Grace John‐Stewart","orcid":"0000-0002-4301-1573","position":11,"is_corresponding":false},{"id":413270,"name":"Pamela Kohler","orcid":"0000-0001-6176-6374","position":12,"is_corresponding":false},{"id":407492,"name":"Kate Wilson","orcid":"0000-0003-1233-5724","position":0,"is_corresponding":true}],"reference_count":60,"raw_metadata":null,"created_at":"2026-07-19T01:15:24.517012Z","pmid":"37390119","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}