The Impact of Youth-Friendly Structures of Care on Retention among HIV-Infected Youth

Limited data exist on how structures of care impact retention among youth living with HIV (YLHIV). We describe the availability of youth-friendly structures of care within HIV Research Network (HIVRN) clinics and examine their association with retention in HIV care. Data from 680 15- to 24-year-old YLHIV receiving care at 7 adult and 5 pediatric clinics in 2011 were included in the analysis. 

The primary outcome was retention in care, defined as completing ≥2 primary HIV care visits ≥90 days apart in a 12-month period. Sites were surveyed to assess the availability of clinic structures defined a priori as 'youth-friendly'. Univariate and multivariable logistic regression models assessed structures associated with retention in care. 

Among 680 YLHIV, 85% were retained. Nearly half (48%) of the 680 YLHIV attended clinics with youth-friendly waiting areas, 36% attended clinics with evening hours, 73% attended clinics with adolescent health-trained providers, 87% could email or text message providers, and 73% could schedule a routine appointment within 2 weeks. Adjusting for demographic and clinical factors, YLHIV were more likely to be retained in care at clinics with a youth-friendly waiting area, evening clinic hours, and providers with adolescent health training. 

Youth-friendly structures of care impact retention in care among YLHIV. Further investigations are needed to determine how to effectively implement youth-friendly strategies across clinical settings where YLHIV receive care.

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By:  Lee L1, Yehia BR2, Gaur AH3, Rutstein R4, Gebo K5, Keruly JC5, Moore RD5, Nijhawan AE6, Agwu AL5.

• 1 Divisions of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine , Baltimore, Maryland.
• 2 Department of Infectious Diseases, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania.
• 3 Department of Infectious Diseases, St. Jude Children's Research Hospital , Memphis, Tennessee.
• 4 Division of General Pediatrics, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
• 5 Divisions of Infectious Diseases, Johns Hopkins School of Medicine , Baltimore, Maryland.
• 6 Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, Texas. 
• AIDS Patient Care STDS. 2016 Apr;30(4):170-7. doi: 10.1089/apc.2015.0263. Epub 2016 Mar 16.

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