Outcomes of a Comprehensive Retention Strategy for Youth With HIV After Transfer to Adult Care in the United States

被引:12
作者
Griffith, David [1 ,2 ]
Jin, Lillian [3 ]
Childs, Jocelyn [4 ]
Posada, Roberto [4 ]
Jao, Jennifer [5 ,6 ]
Agwu, Allison [1 ,2 ]
机构
[1] Johns Hopkins Sch Med, Dept Pediat, Baltimore, MD USA
[2] Johns Hopkins Sch Med, Dept Med, Baltimore, MD USA
[3] Icahn Sch Med Mt Sinai, Dept Med Educ, New York, NY 10029 USA
[4] Icahn Sch Med Mt Sinai, Dept Pediat, New York, NY 10029 USA
[5] Icahn Sch Med Mt Sinai, Dept Med, New York, NY 10029 USA
[6] Icahn Sch Med Mt Sinai, Dept Obstet Gynecol & Reprod Med, New York, NY 10029 USA
关键词
retention; transition of care; youth living with HIV; TRANSITIONING ADOLESCENTS; INFECTED YOUTH; HIV/AIDS; ENGAGEMENT; SERVICES; IMPACT;
D O I
10.1097/INF.0000000000002309
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: The retention of youth living with HIV (YLHIV) in adult care after transfer from pediatric care in the United States is a challenge. A targeted comprehensive retention strategy (CRS) may improve retention among YLHIV. Methods: A retrospective cohort study of YLHIV after transfer from pediatric to adult care for patients with at least 1 adult visit at 2 urban HIV care programs in the United States employing CRSs with internal medicine/pediatrics-trained providers, peer navigators, social workers and mental health resources. Primary outcomes were successful retention in care after transfer (>= 2 provider visits in the adult clinic >= 90 days apart within 1 year of transfer) and successful transition (successful retention plus a stable HIV viral load (VL) defined as VL 1 year after transfer that was less than or equal to the VL obtained at or immediately before transfer). Logistic regression assessed factors associated with successful transition. A subgroup analysis was performed to examine rates of successful transfer and linkage from pediatric to adult clinics (attending at least 1 adult visit after transition). Results: Of the 89 patients included in the study, 79 (89%) patients had successful retention and 53 (60%) had successful transition to the adult program. Factors associated with successful transition included non-African American race [adjusted odds ratio (aOR) = 11.26, 95% confidence interval (CI): 1.32-95.51], perinatal HIV (aOR = 8.00, 95% CI: 1.39-46.02) and CD4 count > 500 cells/mm(3) (aOR = 5.22, 95% CI: 1.54-17.70). Of those who were retained, 53/79 (67%) had stable or improved virologic control at 1 year after transition. In a subgroup analysis, 54/56 (96%) patients who were targeted to transition successfully linked to adult care. Conclusions: Overall, YLHIV in the United States engaged in a CRS program appear to have high retention rates but suboptimal virologic control after transfer from pediatric HIV care.
引用
收藏
页码:722 / 726
页数:5
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