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

      Abstract

      Purpose

      Youth 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.

      Methods

      We 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.

      Results

      Between 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.

      Discussion

      We identified distinct VSTGs that informed long-term trends post-HCT. VSTG membership may allow for tailoring of appropriate HCT support.

      Keywords

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      References

        • Centers for Disease Control and Prevention
        Monitoring selected national HIV prevention and care objectives by using HIV surveillance data--United States and 6 dependent areas, 2017.
        HIV Surv Suppl Rep. 2019; 24
        • Centers for Disease Control and Prevention
        HIV and youth.
        (Available at:)
        • Valenzuela J.M.
        • Buchanan C.L.
        • Radcliffe J.
        • et al.
        Transition to adult services among behaviorally infected adolescents with HIV--a qualitative study.
        J Pediatr Psychol. 2011; 36: 134-140
        • Vijayan T.
        • Benin A.L.
        • Wagner K.
        • et al.
        We never thought this would happen: Transitioning care of adolescents with perinatally acquired HIV infection from pediatrics to internal medicine.
        AIDS Care. 2009; 21: 1222-1229
        • Philbin M.M.
        • Tanner A.E.
        • Chambers B.D.
        • et al.
        Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: Using adolescent and adult providers' insights to create multi-level solutions to address transition barriers.
        AIDS Care. 2017; 29: 1227-1234
        • Straub D.M.
        • Tanner A.E.
        Health-care transition from adolescent to adult services for young people with HIV.
        Lancet Child Adolesc Health. 2018; 2: 214-222
        • Ritchwood T.D.
        • Malo V.
        • Jones C.
        • et al.
        Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: A systematic review.
        BMC Public Health. 2020; 20: 1195
        • Griffith D.
        • Jin L.
        • Childs J.
        • et al.
        Outcomes of a comprehensive retention strategy for youth with HIV after transfer to adult care in the United States.
        Pediatr Infect Dis J. 2019; 38: 722
        • Hussen S.A.
        • Chakraborty R.
        • Knezevic A.
        • et al.
        Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: A retrospective cohort study.
        J Int AIDS Soc. 2017; 20: 21848
        • Xia Q.
        • Abraham B.
        • Shah D.
        • et al.
        Transition from paediatric to adult care among persons with perinatal HIV infection in New York City, 2006-2015.
        AIDS. 2018; 32: 1821-1828
        • Tassiopoulos K.
        • Huo Y.
        • Patel K.
        • et al.
        Healthcare transition outcomes among young adults with perinatally acquired Human Immunodeficiency Virus infection in the United States.
        Clin Infect Dis. 2020; 71: 133-141
        • Wiener L.S.
        • Kohrt B.-A.
        • Battles H.B.
        • Pao M.
        The HIV experience: Youth identified barriers for transitioning from pediatric to adult care.
        J Pediatr Psychol. 2011; 36: 141-154
        • Duff P.
        • Shannon K.
        • Braschel M.
        • et al.
        HIV viral load trajectories of women living with HIV in Metro Vancouver, Canada.
        Int J STD AIDS. 2021; 32: 322-330
        • Kassaye S.G.
        • Wang C.
        • Ocampo J.M.F.
        • et al.
        Viremia trajectories of HIV in HIV-Positive women in the United States, 1994-2017.
        JAMA Netw open. 2019; 2: e193822
        • Hussen S.A.
        • Chakraborty R.
        • Camacho-Gonzalez A.
        • et al.
        Beyond "purposeful and planned": Varied trajectories of healthcare transition from pediatric to adult-oriented care among youth living with HIV.
        AIDS Care. 2019; 31: 45-47
        • Muthén L.K.
        Group-based modeling of development over the Life Course.
        Harvard University Press, Cambridge, MA2005
        • Jones B.L.
        • Nagin D.S.
        • Roeder K.
        A SAS procedure based on mixture models for estimating developmental trajectories.
        Sociological Methods Res. 2001; 29: 374-393
        • Nagin D.S.
        • Odgers C.L.
        Group-based trajectory modeling in clinical research.
        Annu Rev Clin Psychol. 2010; 6: 109-138
        • Foster C.
        • Fidler S.
        Optimizing HIV transition services for young adults.
        Curr Opin Infect Dis. 2018; 31: 33-38
        • Aidala A.A.
        • Wilson M.G.
        • Shubert V.
        • et al.
        Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review.
        Am J Public Health. 2016; 106: e1-e23
        • Chandran A.
        • Edmonds A.
        • Benning L.
        • et al.
        Longitudinal associations between Neighborhood factors and HIV care outcomes in the WIHS.
        AIDS Behav. 2020; 24: 2811-2818
        • Ocampo J.M.
        • Plankey M.
        • Zou K.
        • et al.
        Trajectory analyses of virologic outcomes reflecting community-based HIV treatment in Washington DC 1994-2012.
        BMC Public Health. 2015; 15: 1277