Factors Associated with Retention among Non-Perinatally HIV-Infected Youth in the HIV Research Network

BACKGROUND:

The transmission of human immunodeficiency virus (HIV) among youth through high-risk behaviors continues to increase. Retention in Care is associated with positive clinical outcomes and a decrease in HIV transmission risk behaviors. We evaluated the clinical and demographic characteristics of non-perinatally HIV (nPHIV)-infected youth associated with retention 1 year after initiating care and in the 2 years thereafter. We also assessed the impact retention in year 1 had on retention in years 2 and 3.

METHODS:

This was a retrospective analysis of treatment-naive nPHIV-infected 12- to 24-year-old youth presenting for care in 16 US HIV clinical sites within the HIV Research Network between 2002 and 2008. Multivariate logistic regression identified factors associated with retention.

RESULTS:

Of 1160 nPHIV-infected youth, 44.6% were retained in care during the first year, and 22.4% were retained in all 3 years. Retention in the first year was associated with starting antiretroviral therapy in the first year (adjusted odds ratio [AOR], 3.47 [95% confidence interval (CI), 2.57-4.67]), Hispanic ethnicity (AOR, 1.66 [95% CI, 1.08-2.56]), men who have sex with men (AOR, 1.59 [95% CI, 1.07-2.36]), and receiving care at a pediatric site (AOR, 5.37 [95% CI, 3.20-9.01]). Retention in years 2 and 3 was associated with being retained 1 year after initiating care (AOR, 7.44 [95% CI, 5.11-10.83]).

CONCLUSION:

A high proportion of newly enrolled nPHIV-infected youth were not retained for 1 year, and only 1 in 4 were retained for 3 years. Patients who were Hispanic, were men who have sex with men, or were seen at pediatric clinics were more likely to be retained in care. Interventions that target those at risk of being lost to follow up are essential for this high-risk population.

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By:  Farmer C1, Yehia BR2, Fleishman JA3, Rutstein R4, Mathews WC5, Nijhawan A6, Moore RD7, Gebo KA8, Agwu AL9; HIV Research Network.

• 1Johns Hopkins School of Medicine, Baltimore, Maryland.
• 2Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.
• 3Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland.
• 4Division of General Pediatrics, Children's Hospital of Philadelphia, Pennsylvania.
• 5Department of Clinical Medicine, University of California San Diego Medical Center.
• 6Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
• 7Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
• 8Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
• 9Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland. 
• J Pediatric Infect Dis Soc. 2016 Mar;5(1):39-46. doi: 10.1093/jpids/piu102. Epub 2014 Oct 19.

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