Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study

• Type of Material: Article
• Authors: Sophia Hussen, Emory University; Rana Chakraborty, Emory University; Andrea Knezevic, Emory University; Andres Camacho-Gonzalez, Emory University; Eugene Huang, Emory University; Robert Stephenson, Emory University; Carlos Del Rio, Emory University
• Language: English
• Date: 2017-09-01
• Publisher: Wiley Open Access
• Publication Version: Final Published Version
• Copyright Statement: © 2017 Hussen S A et al; licensee International AIDS Society
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.7448/IAS.20.1.21848
• Title of Journal or Parent Work: Journal of the International AIDS Society
• ISSN: 1758-2652
• Volume: 20
• Issue: 1
• Start Page: 21848
• End Page: 21848
• Grant/Funding Information: This work was supported by a grant from the Emory Medical Care Foundation to S.A.H. S.A.H.'s work on this manuscript is also supported by the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation [Grant# 73309].
• Keywords: Infectious Diseases; care engagement; adolescent; youth; YOUTH; Science & Technology; EXPERIENCE; MEDICINE; INFECTED ADOLESCENTS; HIV; SERVICES; PERINATALLY ACQUIRED HIV; transition; engagement; HEALTH-CARE; Life Sciences & Biomedicine; Immunology; continuum
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health; Biology, Biostatistics

Abstract

INTRODUCTION: The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. METHODS: We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. RESULTS: Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; p = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; p = 0.002). CONCLUSIONS: Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year in the adult setting.