Sage Journals: Discover world-class research

Abstract

Prompt entry into care and retention in care are critical for improving outcomes among HIV-infected individuals. This study identified factors associated with HIV-infected adolescents who delayed entry into HIV care (DEC) after diagnosis of HIV or who fail to remain in care afterward (FRC). We reviewed clinical, demographic, and social data from the records of 202 HIV-positive adolescents (13–21 years old) infected via high-risk behaviors. Strength of association between clinical and social factors and DEC or FRC were estimated with log-linear regression models. DEC occurred in 38% (76/202) of adolescents. Factors independently associated with DEC were unstable residence (RR 1.5; CI: 1.0–2.1) and, compared with less education, college attendance (RR 2.1; CI: 1.5–3.2). FRC occurred in 29% (52/177) of adolescents established in care. Compared with college attendees, high school students (RR: 4.5; CI: 1.2–17.3) and those who dropped out of high school (RR: 4.0; CI: 1.1–15) were more likely to FRC. Compared with adolescents with private insurance, adolescents without insurance (despite access to free care) were more likely to FRC (RR: 2.8; CI: 1.1–6.9). Controlling for sex, adolescents with children were more likely to FRC (RR: 1.8; CI: 1.0–3.1). Interventions to avoid DEC that target HIV-infected adolescents with unstable residences or those diagnosed while attending college are warranted. Among patients engaged in care, those with only high school education or without insurance—which may be markers for socioeconomic status—need additional attention to keep them in care.

Get full access to this article

View all access options for this article.

References

Gardner

, McLees

, Steiner

et al. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis, 2011; 52:793–800.

Branson

, Handsfield

, Lampe

et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR, 2006; 55:1–17.

Kamb

, Fishbein

, Douglas

et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. JAMA, 1998; 280:1161–1167.

Weinhardt

, Carey

, Johnson

, Bickham

. Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985–1997. Am J Public Health, 1999; 89:1397–1405.

Grigoryan

, Hall

, Durant

, Wei

. Late HIV diagnosis and determinants of progression to AIDS or death after HIV diagnosis among injection drug users, 33 US States, 1996–2004. PLoS One, 2009; 4:e4445.

Sabin

, Smith

, Gumley

et al. Late presenters in the era of highly active antiretroviral therapy: Uptake of and responses to antiretroviral therapy. AIDS, 2004; 18:2145–2151.

, Bellamy

, Schwalberg

, Drum

. Factors associated with use of preventive dental and health services among U.S. adolescents. J Adolesc Health, 2001; 29:395–405.

McInerny

, Cull

, Yudkowsky

. Physician reimbursement levels and adherence to American Academy of Pediatrics well-visit and immunization recommendations. Pediatrics, 2005; 115:833–838.

Kroner

, Hoffmann

, Brousseau

. Emergency department reliance: A discriminatory measure of frequent emergency department users. Pediatrics, 2010; 125:133–138.

10.

Flores

, Tomany-Korman

. Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children. Pediatrics, 2008; 121:e286–e298.

11.

Campsmith

, Rhodes

, Hall

, Green

. Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006. J Acquir Immune Defic Syndr, 2010; 53,5:619–624.

12.

Marks

, Gardner

, Craw

, Crepaz

. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. AIDS, 2010; 24:2665–78.

13.

Kissinger

, Cohen

, Brandon

et al. Compliance with public sector HIV medical care. J Natl Med Assoc, 1995; 87:19–24.

14.

Catz

, McClure

, Jones

, Brantley

. Predictors of outpatient medical appointment attendance among persons with HIV. AIDS Care, 1999; 11:361–373.

15.

Israelski

, Gore-Felton

, Power

et al. Sociodemographic characteristics associated with medical appointment adherence among HIV-seropositive patients seeking treatment in a country outpatient facility. Pre Med, 2001; 33:470–475.

16.

Poole

, Perritt

, Shah

et al. A characterization of patient drop outs in a cohort of HIV positive homosexual/bisexual men and intravenous drug users. J Epidemiol Community Health, 2001; 55:66–67.

17.

Sherer

, Stieglitz

, Narra

et al. HIV multidisciplinary teams work: Support services improve access to and retention in HIV primary care. AIDS Care, 2002; 14,Suppl 1:S31–S44.

18.

Arici

, Ripamonti

, Maggiolo

et al. Factors associated with the failure of HIV-positive persons to return for scheduled medical visits. HIV Clin Trials, 2002; 3:52–57.

19.

Giordano

, Gifford

, White

et al. Retention in care: A challenge to survival with HIV infection. Clin Infect Dis, 2007; 44:1493–1499.

20.

Mugavero

, Lin

, Allison

et al. Failure to establish HIV care: Characterizing the “No Show” phenomenon. Clin Infect Dis, 2007; 45:127–30.

21.

Rumptz

, Tobias

, Rajabiun

et al. Factors associated with engaging socially marginalized HIV-positive persons in primary care. AIDS Patient Care STDS, 2007; 21:30–39.

22.

Mugavero

, Lin

, Willig

et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis, 2009; 48:248–256.

23.

Gardner

, Metsch

, Anderson-Mahoney

et al. Efficacy of a brief case management intervention to link recently diagnosed HIV infected persons to care. AIDS, 2005; 19:423–431.

24.

U.S. Census Bureau. 2000. Census 2000 summary file 3: 381 3-digit ZCTARetrieved May 21, 2010http://factfinder.census.gov.

25.

Sutton

, Hardnett

, Wright

et al. HIV/AIDS knowledge scores and perceptions of risk among African American students attending historically black colleges and universities. Public Health Rep, 2011; 126,5:653–663.

26.

Warren-Jeanpiere

, Jones

, Sutton

. Health administrator perspectives on human immunodeficiency virus/acquired immunodeficiency syndrome prevention and services at historically black colleges and universities. J Am Coll Health, 2011; 59:327–329.

27.

Brennan

, Maskew

, Sanne

, Fox

. The importance of clinic attendance in the first six months on antiretroviral treatment: A retrospective analysis at a large public sector HIV clinic in South Africa. J Int AIDS Soc, 2010; 13:49.

Delayed Entry into and Failure to Remain in HIV Care Among HIV-Infected Adolescents

Abstract

Get full access to this article

References