Human Immunodeficiency Virus (HIV) Care Continuum Outcomes After Transition to Adult Care Among a Prospective Cohort of Youth With HIV in Atlanta, Georgia

Abstract Background Healthcare transition from pediatric to adult-oriented clinical settings is often viewed as a high-risk time for care disengagement. However, there is a paucity of prospective, longitudinal research documenting human immunodeficiency virus (HIV) care outcomes after healthcare tra...

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Bibliographic Details
Published in:Clinical infectious diseases 2023-04, Vol.76 (7), p.1218-1224
Main Authors: Hussen, Sophia A, Doraivelu, Kamini, Goldstein, Madeleine H, Shenvi, Neeta, Easley, Kirk A, Zanoni, Brian C, Camacho-González, Andrés, del Río, Carlos
Format: Article
Language:English
Subjects:
Adolescent
Adult
Child
Continuity of Patient Care
Georgia - epidemiology
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
Humans
Male
Prospective Studies
Transition to Adult Care
Viral Load
Young Adult
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Summary:Abstract Background Healthcare transition from pediatric to adult-oriented clinical settings is often viewed as a high-risk time for care disengagement. However, there is a paucity of prospective, longitudinal research documenting human immunodeficiency virus (HIV) care outcomes after healthcare transition. Methods We conducted a prospective, observational cohort study of healthcare transition among youth enrolled at an HIV care center in Atlanta, Georgia. Pediatric clinic patients (average age, 24 years) were enrolled up to 3 months before the expected transition and were followed up to determine linkage, retention, and viral suppression in adult care through electronic medical record abstractions at the baseline and at 6, 12, 18, and 24 months. Results The majority of our cohort (n = 70) was male (88.6%) and black (92.9%) and acquired HIV horizontally (80%). Most of our cohort was linked to adult care by 12 months (84%) after enrollment. Of those who linked to adult care by 12 months, retention rates were 86% (95% confidence interval, 78%–94%) at 6 months, 76% (66%–86%) at 12 months, and 66% (55%–78%) at 18 and 24 months. Once in adult care, the proportion with viral suppression was stable (73% at baseline and 74%, 77%, 67%, and 78% at 6, 12, 18, and 24 months, respectively). Conclusions Although most youth successfully linked to adult care, retention rates decreased over the 24-month follow-up period. Rates of viral suppression were stable for those who remained in care. Strategies to support retention in adult care will be critical to optimizing this transition for youth with HIV. In our prospective, single-center cohort of youth with human immunodeficiency virus, we found that initial linkage to adult care was high; however, rates of retention in care declined significantly over a 2-year follow-up period.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciac904