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.

Highlights

  • The transition from paediatric to adult HIV care is a high-risk time for disengagement among young adults; empirical data are lacking

  • Youth living with HIV (YLHIV) ages 13–24 in the US often enter into HIV care in a paediatric clinical setting before undergoing transition to adultoriented healthcare

  • The Infectious Disease Program (IDP) clinic is entirely dedicated to the care of people living with HIV and serves a low socioeconomic status population, most of whom fall below federally defined poverty levels

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Summary

Introduction

The transition from paediatric to adult HIV care is a high-risk time for disengagement among young adults; empirical data are lacking. Youth living with HIV (YLHIV) ages 13–24 in the US often enter into HIV care in a paediatric clinical setting before undergoing transition to adultoriented healthcare This transition period has been posited as a high-risk time for disengagement from care; empirical data on this topic are relatively scarce [3,4]. The body of transition research focuses more on vertically (perinatally) than horizontally (behaviourally) infected youth, despite the fact that the majority of YLHIV in the US acquired infection sexually during adolescence [8]. This discrepancy is due in large part to regional and national differences in normative transition processes. Transition in the US typically occurs in the mid-20s, and the majority of transitioning patients have horizontally acquired infection, with a preponderance of these YLHIV being young men who have sex with men [10]

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