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

Griffith, David MD*,†; Jin, Lillian MPH; Childs, Jocelyn LCSW§; Posada, Roberto MD§; Jao, Jennifer MD, MPH¶,‖; Agwu, Allison MD, ScM*,†

The Pediatric Infectious Disease Journal: July 2019 - Volume 38 - Issue 7 - p 722–726
doi: 10.1097/INF.0000000000002309
HIV Reports
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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/mm3 (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.

From the Departments of *Pediatrics

Medicine, Johns Hopkins School of Medicine, Baltimore, MD

Departments of Medical Education

§Pediatrics

Medicine

Obstetrics, Gynecology, and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

Accepted for publication February 10, 2019.

D.G. was supported by T32AI052071 and J.J. was supported by NICHD K23HD070760 during the preparation of this manuscript.

The authors have no conflicts of interest to disclose.

D.G. and L.J. are co-first authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: David Griffith, MD, 725 North Wolfe Street, Suite 211, Baltimore, MD 21205. E-mail: dgriff50@jhmi.edu.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.