Caring for youth living with HIV across the continuum: turning gaps into opportunities

Abstract

With the increasing proportion of youth living with human immunodeficiency virus (YLHIV) and the aging of the perinatally infected population, there is a need for clinical services that are "youth friendly" to address the multiple challenges YLHIV face in terms of engagement in care and maintenance of combination antiretroviral therapy (cART). Little is known about how and where YLHIV receive their care. Further, the impact of the care structure on engagement and retention outcomes for YLHIV is ill defined. In order to better classify how YLHIV receive care in the United States, we performed a review of published literature characterizing the structure and outcomes of care for YLHIV. Several key concepts emerged: 1. The majority of YLHIV (13-24 years old) are cared for at adult sites, 2. Clinics providing care to YLHIV are varied in terms of the services offered and the types of services offered can impact outcomes, 3. YLHIV cared for in adult clinical sites have poor retention and antiretroviral treatment initiation, and 4. YLHIV cared for at adult sites had poorer retention and cART outcomes compared to YLHIV cared for at pediatric sites. There were no studies identified that specifically examined "youth friendly" care for YLHIV within the context of adult clinical sites. The results of this review highlight disparities for YLHIV and the need for interventions to improve outcomes for YLHIV in the context of adult care.

Implementing a Comprehensive Hepatitis C Virus (HCV) Clinic Within a Human Immunodeficiency Virus Clinic: A Model of Care for HCV Microelimination

“…Additional help can be provided by the clinic to female patients through support services such as medical case management and counseling [35]. In general, the younger patient population (<30 years old) has been a challenging group to retain in HIV care as noted by Griffith et al [36]. This gap in retention is due to many barriers such as unemployment, unstable housing, mental health issues, and substance use.…”

Interest of Youth Living With HIV in Long-Acting Antiretrovirals

“…7 YHIV including those who struggle with sustaining adherence to oral ARVs may be an ideal target population for such an intervention within the setting of a youth-friendly program. 8 Critically absent from existing data is the youth perspective on LAARV technologies. There is a knowledge gap on the readiness of YHIV to adopt and adhere to LAARV.…”

Point-of-care viral load testing among adolescents and young adults living with HIV in Haiti: a randomized control trial

“…Prior review of routine care at GHESKIO found 68% of adolescents were retained in care at 12 months, less than the 93% follow-up achieved in our study (Reif et al, 2016). Loss and inconsistent HIV caredisengaging and re-engaging from regular follow-upis common among adolescents (Griffith & Agwu, 2017;Mark et al, 2017;Murray et al, 2017). Completing VL testing over multiple visits risks patient loss before poor outcomes can be identified and addressed.…”