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Quicker referral time to youth-friendly care services could help younger patients with HIV achieve better outcomes.
Youth with newly-diagnosed HIV are less likely to achieve viral suppression compared with adults, indicating a need for better interventions tailored toward adolescents and young adults, according to a new study published in the Journal of Acquired Immune Deficiency Syndrome.1
The study, which used a large national sample of predominantly newly-diagnosed youths, found that individuals aged 13 to 24 years of age diagnosed with HIV achieved disproportionately lower rates of viral suppression. According to the study authors, youths have the poorest HIV Care Continuum (HCC) outcomes, despite having similar rates of enrollment in medical care.
The researchers analyzed data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions. More than 1000 individuals, most of whom were newly enrolled in care at treatment centers, were included in the analysis. Adolescents and young adults were enrolled in care through the Strategic Multisite Initiative for the Identification, Linkage and Engagement in Care of Youth Collaborative.
Of the 1411 individuals in the study, 75% were linked, 59% engaged, and 34% retained in care at adolescent health care sites. Thirty-four percent initiated antiretroviral therapy (ART) and 12% achieved viral suppression, according to the study.
Predictors of viral suppression included lower viral load at baseline [aHR 1.56 (95% CI: 1.32-1.89), p<0.0001], recent ART receipt [aHR 3.10 (95% CI: 1.86-5.18), p<0.0001], and shorter time from HIV testing until referral to linkage coordinate [aHR 2.52 (95% CI: 1.50-4.23), p=0.0005 for 7 days to 6 weeks and aHR 2.08 (95% CI: 1.08-4.04), p=0.0294 for 6 weeks to 3 months compared to >3 months].
Compared with youth referred to care after 3 months, those referred within 1 to 6 weeks were 2.5 times more likely to reach viral suppression. Those referred from 6 weeks to 3 months were roughly twice as likely to reach viral suppression, according to the authors.
“Prompt referral to youth-friendly linkage to services was an independent predictor of [viral suppression],” the authors wrote. “Youth-focused interventions are urgently needed to improve their HCC outcomes.” They suggested the use of trained peer counseling and maintaining frequent contact with youth patients through text and social media as important interventions, as well as additional strategies to ensure that youth enroll and remain in care.
“Our findings indicate an urgency for research on how best to tailor HIV intervention services to the needs of youth,” first study author Bill G Kapogiannis, MD, of the Maternal and Pediatric Infectious Diseases Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Head and Human Development, said in a news release.2
1. Kapogiannis BG, Koenig LJ, Jiahong X, et al. The HIV Continuum of Care for Adolescents and Young Adults Attending 13 Urban US HIV Care Centers of the NICHD-ATN-CDC-HRSA SMILE Collaborative. Journal of Acquired Immune Deficiency Syndrome. 2020. Doi: 10.1097/QAI.0000000000002308
2. Release: Youth with HIV less likely than adults to achieve viral suppression [news release]. National Institutes of Health’s website. https://www.nichd.nih.gov/newsroom/news/021020-HIV. Accessed February 10, 2020.