Michelle A Lally1, Jacob J van den Berg2, Andrew O Westfall3, Bret J Rudy4, Sybil G Hosek5, J Dennis Fortenberry6, Dina Monte7, Mary R Tanney8, Elizabeth J McFarland9, Jiahong Xu7, Bill G Kapogiannis10, Craig M Wilson11. 1. Department of Medicine, Lifespan Hospital Systems, Alpert Medical School of Brown University, VA Medical Center, Providence, RI. 2. Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI. 3. Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL. 4. Department of Pediatrics, New York University School of Medicine, New York, NY. 5. Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, IL. 6. Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN. 7. Health Studies Sector, Westat, Rockville, MD. 8. Department of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 9. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. 10. Eunice Kennedy Shriver National Institute of Child Health and Human Development/Maternal and Pediatric Infectious Disease Branch, Bethesda, MD. 11. Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL.
Abstract
BACKGROUND: Beneficial HIV treatment outcomes require success at multiple steps along the HIV Continuum of Care. Youth living with HIV are a key population, and sites in the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) are known for modeling optimum HIV adolescent care. METHODS: A longitudinal cohort study conducted at 14 network sites across the United States assessed how the later steps of the Continuum of Care were achieved among the youth: engagement, treatment, and viral load (VL) suppression. Youth aged 13-24 who were behaviorally infected with HIV and linked to care at an ATN-affiliated site were eligible to participate. RESULTS: A total of 467 youth were enrolled and had 1 year of available data. Most were aged 22-24 (57%), male (79%), and black/non-Hispanic (71%). Most used alcohol (81%) and marijuana (61%) in the 3 months before enrollment, and 40% had a history of incarceration. Among this cohort of youth, 86% met criteria for care engagement; among these, 98% were prescribed antiretroviral therapy and 89% achieved VL suppression. Sustained VL suppression at all measured time points was found among 59% with initial suppression. Site characteristics were notable for the prevalence of adherence counseling (100%), case management (100%), clinic-based mental health (93%), and substance use (64%) treatment. CONCLUSIONS: Youth living with HIV in the United States can be successfully treated at health care sites with experience, excellence, and important resources and services. Sustained VL suppression may be an important step to add to the Continuum of Care for youth.
BACKGROUND: Beneficial HIV treatment outcomes require success at multiple steps along the HIV Continuum of Care. Youth living with HIV are a key population, and sites in the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) are known for modeling optimum HIV adolescent care. METHODS: A longitudinal cohort study conducted at 14 network sites across the United States assessed how the later steps of the Continuum of Care were achieved among the youth: engagement, treatment, and viral load (VL) suppression. Youth aged 13-24 who were behaviorally infected with HIV and linked to care at an ATN-affiliated site were eligible to participate. RESULTS: A total of 467 youth were enrolled and had 1 year of available data. Most were aged 22-24 (57%), male (79%), and black/non-Hispanic (71%). Most used alcohol (81%) and marijuana (61%) in the 3 months before enrollment, and 40% had a history of incarceration. Among this cohort of youth, 86% met criteria for care engagement; among these, 98% were prescribed antiretroviral therapy and 89% achieved VL suppression. Sustained VL suppression at all measured time points was found among 59% with initial suppression. Site characteristics were notable for the prevalence of adherence counseling (100%), case management (100%), clinic-based mental health (93%), and substance use (64%) treatment. CONCLUSIONS: Youth living with HIV in the United States can be successfully treated at health care sites with experience, excellence, and important resources and services. Sustained VL suppression may be an important step to add to the Continuum of Care for youth.
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