Background
Health care transition (HCT) from pediatric/adolescent (P/A) to adult HIV care is a period of care continuum vulnerability. Outcomes of HIV HCT in the U.S. have only been studied up to 24 months post-transition and have not included the COVID pandemic. The University of Maryland STEP Program is a multi-disciplinary HCT program staffed by pediatric and adult providers and staff. It includes early engagement with an adult HIV provider in the P/A clinic and a comprehensive retention model pre- and post-transition. We sought to examine HCT outcomes among patients in the STEP Program 5 years post-transition and through the COVID pandemic.
Methods
This was a retrospective cohort study of patients enrolled in the STEP program. The primary end point was retention in adult care, defined as ≥2 visits within 12 months, separated by ≥ 90 days. Secondary end points included missed visits in adult care, completed first time HCT visits, viral suppression, and care engagement during COVID. We used descriptive statistics to characterize the study population.
Results
102 patients enrolled in STEP during the study period. 84 transitioned from P/A to adult care. The cohort was 58% male, 97% African American, and 53% acquired HIV perinatally. The median age at transition was 29 and 49% carried a mental health diagnosis. 75 transitioned to the UMB THRIVE Program and 10 transitioned elsewhere. Retention in care was 89.3% (N=75) at 12 months, 75.8% at 24 months (N= 58), 85.4% at 36 months (N= 41), 72.7% at 48 months (N=33) and 68% at 60 months (N= 25). HIV viral suppression was 62.3% pre-transition. Post-transition it increased to 68.2% at 12 months, 71.7% at 24, 77.8% at 36, 78.6% at 48, and 84.2% at 60. In 2020, 76.6% (N=30) of patients met retention criteria. Mean new HIV HCTs from 2017-2019 were 1.15 per month. From 3/2020 to 1/2021 there were none. From 1/2021-6/2023, mean new HCTs increased to 1.07 per month.
Conclusions
Retention in adult care was highest in the first 12 months post-transition with a 23% decrease by 60 months. Rates of viral suppression increased with highest rates of suppression at 60 months. New HIV HCTs ceased for the first 9 months of COVID, however rates of transition soon returned to pre-pandemic levels. Retention in care and viral suppression did not significantly change before and during COVID time-period. Overall, these results support the durability of a multi-disciplinary, pediatric/adult-integrated comprehensive retention service-based health care transition program.