Title | The HIV Continuum of Care for Adolescents and Young Adults Attending 13 Urban US HIV Care Centers of the NICHD-ATN-CDC-HRSA SMILE Collaborative. |
Publication Type | Publication |
Year of Publication | 2020 |
Authors | Kapogiannis BG, Koenig LJ, Xu J, Mayer KH, Loeb J, Greenberg L, Monte D, Banks-Shields M, J Fortenberry D |
Corporate Authors | Adolescent Medicine Trials Network for HIV/AIDS Interventions |
Journal | J Acquir Immune Defic Syndr |
Volume | 84 |
Issue | 1 |
Pagination | 92-100 |
Date Published | 2020 May 01 |
ISSN | 1944-7884 |
Keywords | Adolescent, CD4 Lymphocyte Count, Child, Continuity of Patient Care, Cooperative Behavior, Female, HIV Infections, Humans, Male, United States, Urban Health Services, Viral Load, Young Adult |
Abstract | <p><b>BACKGROUND: </b>Almost one-quarter of all new HIV diagnoses in the United States occur among persons aged 13-24 years. These youths have the poorest HIV care continuum (HCC) outcomes, yet few empirical youth-specific data are available.</p><p><b>METHODS: </b>The Strategic Multisite Initiative for the Identification, Linkage, and Engagement in Care of HIV-infected youth (SMILE) helped HIV-infected (mostly newly diagnosed) youth, aged 12-24 years, link to youth-friendly care, and evaluated each milestone of the HCC (October 2012-September 2014). Numbers of HIV-infected youth referred, linked, engaged, and retained in care were recorded, along with sociodemographics. Viral suppression (VS) was defined as ≥1 HIV viral load (VL) below the level of detection on study. Correlates of VS were examined using Cox proportional hazards models.</p><p><b>RESULTS: </b>Among 1411 HIV-infected youth, 1053 (75%) were linked, 839 (59%) engaged, and 473 (34%) retained in care at adolescent health care sites. Antiretroviral therapy was initiated among 474 (34%), and 166 (12%) achieved VS. Predictors of VS included lower VL at baseline [aHR 1.56 (95% CI: 1.32-1.89), P < 0.0001], recent antiretroviral therapy receipt [aHR 3.10 (95% CI: 1.86-5.18), P < 0.0001], and shorter time from HIV testing until referral to linkage coordinator [aHR 2.52 (95% CI: 1.50-4.23), P = 0.0005 for 7 days to 6 weeks and aHR 2.08 (95% CI: 1.08-4.04), P = 0.0294 for 6 weeks to 3 months compared with >3 months].</p><p><b>CONCLUSIONS: </b>Although this large national sample of predominately newly diagnosed youths linked to care at similar rates as adults, they achieved disproportionately lower rates of VS. Prompt referral to youth-friendly linkage services was an independent predictor of VS. Youth-focused interventions are urgently needed to improve their HCC outcomes.</p> |
DOI | 10.1097/QAI.0000000000002308 |
Alternate Journal | J Acquir Immune Defic Syndr |
PubMed ID | 32267659 |
PubMed Central ID | PMC7147723 |
Grant List | P30 AI060354 / AI / NIAID NIH HHS / United States U01 HD040474 / HD / NICHD NIH HHS / United States U01 HD040533 / HD / NICHD NIH HHS / United States |