Young adults with HIV (YAHIV) are less likely to be retained in care or achieve viral suppression when seen in adult clinics. We assessed outcomes of YAHIV newly entering or transitioning from pediatric care into a youth-focused care model embedded in an adult HIV clinic.
The Accessing Care Early (ACE) program for YAHIV is embedded in a large adult HIV clinic. Providers are internal medicine/pediatrics trained; the support team includes a nurse, social worker, and peer navigator. Eligibility for ACE includes age 18-30 years with ≥1 criteria: transfer from pediatric care, mental illness, substance abuse, or known adherence issues. Ineligible patients receive standard of care (SOC) in the general adult clinic. We performed a retrospective analysis of patients 18-30 years old entering ACE vs SOC from 2012-2014. Multivariable logistic regression assessed retention, HIV viral suppression (VS) < 200 copies/mL, and the association between clinical services utilization (nurse visits and telephone calls, social work visits, psychiatry visits, and peer navigator communication) and retention and VS.
137 patients entered care (2012-2014), 61 ACE and 76 SOC. In ACE 23% had perinatal HIV vs 3% in SOC; 39% of ACE transitioned from pediatric care compared to 5% in SOC. ACE YAHIV were more likely to have substance abuse, mental health disorder, and less education. Overall ACE YAHIV were less likely to be lost to follow up compared to SOC (16% vs. 37%, p<0.01). At 24 months 49% in ACE vs. 26% in SOC met the retention measure, (P<0.01). Adjusting for age, gender, race, HIV risk, viral load, CD4, mental health, and substance abuse, ACE was associated with retention in care (AOR 3.26 [1.23-8.63]). For those who met the retention measure, 60% (15/25) of ACE versus 89% (16/18) of SOC were virally suppressed (AOR 0.63 [0.35-1.14]). Adjusting for ACE vs. SOC, more frequent social work visits and nurse phone calls was associated with retention. Appointments were less likely to be missed if peer navigator confirmed via a bi-directional communication (OR 2.69 [1.64-4.42]).
The youth-focused ACE program successfully identified YAHIV at high risk for attrition and viremia. Despite comprising higher risk YHIV, ACE had better retention compared to SOC for YAHIV in an adult clinic. Improved retention did not to lead to improved VS compared to the SOC, underscoring the challenges with adherence and need for additional interventions to optimize VS for YAHIV.