Youth aged 13‒24 are less likely to be retained in HIV care and be virally suppressed than older age groups. This study aimed to assess predictors of retention in HIV care and viral suppression among a population-based cohort of youth (N = 2872) diagnosed with HIV between 1993 and 2014 in Florida. We used generalized estimating equations to estimate prevalence ratios (PRs). Retention in care was defined as evidence of engagement in care (at least one laboratory test, physician visit, or antiretroviral therapy prescription refill), two or more times, at least three months apart during 2015. Viral suppression was defined as having evidence of a viral load <200 copies/ml among those in care during 2015. Among the 2872 youth, 65.4% were retained in care, and among those in care, 65.0% were virally suppressed. Older youth (18‒24 years old) and non-Hispanic Blacks (NHBs) were less likely to be retained in care, whereas those men who have sex with men, perinatal HIV transmission, living in low socioeconomic neighborhoods, and those diagnosed with AIDS before 2016 were more likely to be retained in care. Those diagnosed with AIDS before 2016 and NHBs were less likely to be virally suppressed, whereas those men who have sex with men and foreign-born persons were more likely to be virally suppressed. Results suggest the need for targeted retention and viral suppression interventions for NHB youth and older youth (18‒24 years-age).
KayESBateyDSMugaveroMJ.The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther2016;
13: 35.
4.
LimaVDHoggRSHarriganPR, et al.
Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS2007;
21: 685–692.
5.
MontanerJS.Treatment as prevention – a double hat-trick. Lancet2011;
378: 208–209.
6.
PhilbinMMTannerAEDuvalA, et al.
Linking HIV-positive adolescents to care in 15 different clinics across the United States: creating solutions to address structural barriers for linkage to care. AIDS Care2014;
26: 12–19.
7.
UlettKBWilligJHLinHY, et al.
The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS2009;
23: 41–49.
8.
AlthoffKNRebeiroPBrooksJT, et al.
Disparities in the quality of HIV care when using US Department of Health and Human Services indicators. Clin Infect Dis2014;
58: 1185–1189.
9.
BeerLMattsonCLShouseRL, et al.
Receipt of clinical and prevention services, clinical outcomes, and sexual risk behaviors among HIV-infected young adults in care in the United States. AIDS Care2016;
28: 1166–1170.
10.
LallPLimSHKhairuddinN, et al.
Review: an urgent need for research on factors impacting adherence to and retention in care among HIV-positive youth and adolescents from key populations. J Int AIDS Soc2015;
18: 19393.
11.
KahanaSYJenkinsRABruceD, et al.
Structural determinants of antiretroviral therapy use, HIV care attendance, and viral suppression among adolescents and young adults living with HIV. PLoS One2016;
11: e0151106.
12.
ShachamELianMOnenNF, et al.
Are neighborhood conditions associated with HIV management?HIV Med2013;
14: 624–632.
13.
HigaDHMarksGCrepazN, et al.
Interventions to improve retention in HIV primary care: a systematic review of U.S. studies. Curr HIV/AIDS Rep2012;
9: 313–325.
14.
FarmerCYehiaBRFleishmanJA, et al.
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network. J Pediatric Infect Dis Soc2016;
5: 39–46.
15.
ZanoniBCSibayaTCairnsC, et al.
Higher retention and viral suppression with adolescent-focused HIV clinic in South Africa. PLoS One2017;
12: e0190260.
16.
CruzMLCardosoCADarmontMQ, et al.
Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: results of a multicenter study. J Pediatr (Rio J)2014;
90: 563–571.
17.
KahanaSYFernandezMIWilsonPA, et al.
Rates and correlates of antiretroviral therapy use and virologic suppression among perinatally and behaviorally HIV-infected youth linked to care in the United States. J Acquir Immune Defic Syndr2015;
68: 169–177.
18.
Centers for Disease Control and Prevention.
Revised surveillance case definition for HIV infection – United States, 2014. MMWR Recomm Rep2014;
63: 1–10.
ZouG.A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol2004;
159: 702–706.
24.
RyscavagePAndersonEJSuttonSH, et al.
Clinical outcomes of adolescents and young adults in adult HIV care. J Acquir Immune Defic Syndr2011;
58: 193–197.
25.
SheehanDMMauckDEFennieKP, et al.
Black-white and country of birth disparities in retention in HIV care and viral suppression among Latinos with HIV in Florida, 2015. Int J Environ Res Public Health2017;
14: pii: E120.
26.
FreemanRGwadzMVSilvermanE, et al.
Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/black and Hispanic persons living with HIV in the United States: a qualitative exploration. Int J Equity Health2017;
16: 3.
27.
GastonGBAlleyne-GreenB.The impact of African Americans’ beliefs about HIV medical care on treatment adherence: a systematic review and recommendations for interventions. AIDS Behav2013;
17: 31–40.
28.
KahnJGZhangXCrossLT, et al.
Access to and use of HIV antiretroviral therapy: variation by race/ethnicity in two public insurance programs in the U.S. Public Health Rep2002;
117: 2.
29.
WesterCRebeiroPFShavorTJ, et al.
The 2013 HIV continuum of care in Tennessee: progress made, but disparities persist. Public Health Rep2016;
131: 695–703.
30.
Van DykeRBPatelKSiberryGK, et al.
Antiretroviral treatment of US children with perinatally acquired HIV infection: temporal changes in therapy between 1991 and 2009 and predictors of immunologic and virologic outcomes. J Acquir Immune Defic Syndr2011;
57: 165–173.
31.
CerviaJS.Easing the transition of HIV-infected adolescents to adult care. AIDS Patient Care STDS2013;
27: 692–696.
32.
HussenSAChahroudiABoylanA, et al.
Transition of youth living with HIV from pediatric to adult-oriented healthcare: a review of the literature. Future Virol2015;
9: 921–929.
33.
ThakerHKSnowMH.HIV viral suppression in the era of antiretroviral therapy. Postgrad Med J2003;
79: 36–42.
34.
EdisonLHughesDDrenzekC, et al.
Prevalence and indicators of viral suppression among persons with diagnosed HIV infection retained in care – Georgia, 2010. MMWR Recomm Rep2014;
63: 55–58.
35.
DeroseKPBahneyBWLurieN, et al.
Review: immigrants and health care access, quality, and cost. Med Care Res Rev2009;
66: 355–408.
36.
MyersTRLinXSkarbinskiJ.Antiretroviral therapy and viral suppression among foreign-born HIV-infected persons receiving medical care in the United States: a complex sample, cross-sectional survey. Medicine2016;
95: e3051.
37.
EberhartMGYehiaBRHillierA, et al.
Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression. J Acquir Immune Defic Syndr2015;
69: 37.
38.
RossCEMirowskyJ.Neighborhood socioeconomic status and health: context or composition?City Community2008;
7: 163–179.
39.
KramerMRHogueCR.Is segregation bad for your health?Epidemiol Rev2009;
31: 178–194.
40.
BrownEJPolskyDBarbuCM, et al.
Racial disparities in geographic access to primary care in Philadelphia. Health Aff2016;
35: 1374–1381.
41.
BulsaraSMWainbergMLNewton-JohnT.Predictors of adult retention in HIV care: a systematic review. AIDS Behav2018;
22: 752–764.
