Paper Title
Healthcare Transition for Youth Living With HIV: Outcomes from a Prospective Multi-site Study
Keywords
- healthcare transition
- youth living with hiv
- hiv care continuum
- adolescent hiv
- hiv treatment adherence
- antiretroviral therapy
- viral suppression
- hiv care engagement
- healthcare disparities
- transition to adult care
- hiv and insurance
- disclosure stigma
- adolescent clinics
- adult hiv care
- retention in care
- minority health
- sexual minority youth
- hiv public health
- hiv policy
- multisite study
- longitudinal research
- healthcare access
- patient outcomes
- clinic best practices
- hiv support services
- healthcare barriers
- medicaid and hiv
- hiv youth services
- adolescents
- hiv
- clinical care
- healthcare
- transition
- youth
- living
- care
- continuum
- adolescent
- treatment
- adherence
- antiretroviral
- therapy
- viral
- suppression
- engagement
- disparities
- adult
- insurance
- disclosure
- stigma
- clinics
- retention
- minority
- public
- policy
- multisite
- study
- longitudinal
- research
- access
- patient
- outcomes
- best
- practices
- support
- services
- barriers
- medicaid
Article Type
Original Article
Journal
Research Impact Tools
Publication Info
Volume: 63 | Issue: 2 | Pages: 157–165
Published On
August, 2018
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Abstract
Purpose Youth living with HIV (YLHIV) in the United States (U.S.) account for nearly one-third of new HIV infections and face significant barriers to care engagement; only 25% are virally suppressed. Healthcare transition (HCT) from pediatric/adolescent to adult-oriented care can be particularly disruptive. Accordingly, we prospectively examined HCT processes at 14 distinct geographical sites across the U.S. Methods We collected Audio Computer-Assisted Self-Interviews data and abstracted electronic medical records from 135 HCT-eligible YLHIV at baseline and 9-month follow-up. Descriptive analyses and multilevel modeling were conducted. Data also included qualitative interviews with 28 adolescent and 30 adult providers across 14 adolescent and 20 adult clinics, respectively. Interviews were analyzed using the constant comparative method; this analysis focused on specific HCT recommendations. Results At baseline, youth were primarily age 24 (78.8%), male (76.8%), black (78.0%), identified as a sexual minority (62.9%), had attended an HIV appointment in the past 3 months (90.2%), had Medicaid for insurance (65.2%), and were always or mostly always adherent to their antiretroviral therapy (65.9%). At the 9-month follow-up only 37% of YLHIV successfully transitioned to adult care. Both individual-level (insurance status and disclosure-related stigma) and clinic-level (adolescent clinic best practices) factors were significant. Adolescent and adult clinic staff offered recommendations to support HCT; these focused primarily on clinical changes. Conclusions This study highlights the complex set of individual- and clinic-level factors associated with HCT. Addressing these key factors is essential for developing streamlined, comprehensive, and context-specific HCT protocols to support continuous care engagement for YLHIV.
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