The HIV Continuum of Care for Adolescents and Young Adults Attending 13 Urban US HIV Care Centers of the NICHD-ATN-CDC-HRSA SMILE Collaborative

Abstract

Background: Almost one-quarter of all new HIV diagnoses in the United States occur among persons aged 13-24 years. These youths have the poorest HIV care continuum (HCC) outcomes, yet few empirical youth-specific data are available.

Methods: The Strategic Multisite Initiative for the Identification, Linkage, and Engagement in Care of HIV-infected youth (SMILE) helped HIV-infected (mostly newly diagnosed) youth, aged 12-24 years, link to youth-friendly care, and evaluated each milestone of the HCC (October 2012-September 2014). Numbers of HIV-infected youth referred, linked, engaged, and retained in care were recorded, along with sociodemographics. Viral suppression (VS) was defined as ≥1 HIV viral load (VL) below the level of detection on study. Correlates of VS were examined using Cox proportional hazards models.

Results: Among 1411 HIV-infected youth, 1053 (75%) were linked, 839 (59%) engaged, and 473 (34%) retained in care at adolescent health care sites. Antiretroviral therapy was initiated among 474 (34%), and 166 (12%) achieved VS. Predictors of VS included lower VL at baseline [aHR 1.56 (95% CI: 1.32-1.89), P < 0.0001], recent antiretroviral therapy receipt [aHR 3.10 (95% CI: 1.86-5.18), P < 0.0001], and shorter time from HIV testing until referral to linkage coordinator [aHR 2.52 (95% CI: 1.50-4.23), P = 0.0005 for 7 days to 6 weeks and aHR 2.08 (95% CI: 1.08-4.04), P = 0.0294 for 6 weeks to 3 months compared with >3 months].

Conclusions: Although this large national sample of predominately newly diagnosed youths linked to care at similar rates as adults, they achieved disproportionately lower rates of VS. Prompt referral to youth-friendly linkage services was an independent predictor of VS. Youth-focused interventions are urgently needed to improve their HCC outcomes.

Figure 1.

A) Proportions of youth who achieved HIV viral load suppression below the assay limit of detection at each succesive care interval after linkage and through retention, and B) the youth-specific HIV care continuum among adolescent and young adult participants attending 13 urban US centers of the NICHD-ATN-CDC-HRSA SMILE Collaborative. Care intervals along the HIV Care Continuum were defined for LTC: a clinical visit attended no later than 42 days after referral for linkage; EIC: at least one additional clinical visit attended no later than 16 weeks after LTC; RIC: at least one additional clinical visit attended no later than 52 weeks after EIC; and, *Post-RIC: a second clinical visit attended within 52 weeks after EIC, if the RIC visit occured early in the interval.