Factors and Outcomes Associated With Viral Suppression Trajectory Group Membership Among Youth Transitioning From Pediatric to Adult HIV Care

Abstract

PurposeYouth experiencing healthcare transition (HCT) from pediatric to adult HIV care are at risk for poor viral suppression (VS). We have a limited understanding of VS trajectory groups (VSTGs) pre- and post-HCT and factors associated with these trajectories. MethodsWe analyzed Philadelphia HIV surveillance data of youth diagnosed with HIV at least 2 years pre-HCT. We used group-based trajectory analysis to characterize VS trends pre- and post-HCT. We compared baseline sociodemographic characteristics across the different VSTGs and care continuum outcomes in the year post-HCT. Generalized estimating equations evaluated the association between VSTG and HIV care continuum outcomes measured 2 years post-HCT. ResultsBetween 2012 and 2019, 232 eligible youth underwent HCT: 69.4% were aged 24–25, 75.4% male, and 76.7% non–Hispanic Black. Three VSTGs were identified: low (30.6%), increasing (26.7%), and high probability (42.7%) for VS. Younger age was associated with high-probability VSTG membership: 59.2% of those aged 18–23 versus 35.4% of those aged 24–25 were in the high-probability VSTG (p < .001). Demographics found to be associated with linkage to care post-HCT included younger age (p = .018), female sex at birth (p = .038), and perinatal acquisition (p = .012). Perinatal acquisition was also associated with retention in care in the year post-HCT (p = .029). For those transitioning between 2012 and 2018, those in the high-probability VSTG had greater odds of being retained (adjusted odds ratio 1.68, 95% confidence interval 1.03–2.71) and VS (adjusted odds ratio 6.95, interval 3.74–12.95) 2 years post-HCT, compared to those in the low VSTG. DiscussionWe identified distinct VSTGs that informed long-term trends post-HCT. VSTG membership may allow for tailoring of appropriate HCT support.