Centralization of HIV services in HIV-positive African-American and Hispanic youth improves retention in care

Abstract

African-American and Hispanic HIV-infected youth are a high risk group for not remaining in HIV care. We examined differences in retention in care among 174 HIV-infected African-American and Hispanic youth between 13 and 23 years old who presented for HIV primary care between 1 January 2002 and 31 August 2008. Patients were included in three service eras, based on when they entered the clinic: when no youth-specific services were available (the decentralized era), after formation of a youth clinic staffed by adolescent providers and a case-manager (the centralized era), and after educational activities and support groups were added and the social services staff were trained in the use of motivational interviewing (the centralized with supportive services era). Patient and attendance data for the 12-months following entry into care were captured. Retention in HIV care was examined using two different measures: adequate visit constancy (at least three quarters with at least one visit in each quarter) and having a gap in care (two consecutive medical visits ≥180 days apart). Adequate visit constancy improved by service era from 31% in the decentralized era to 57% in the centralized era and 65% in the centralized with supportive services era (p=0.01). The percent of patients with no gap in care remained stable at about 80% in the decentralized and centralized eras, but then increased to 96% in the centralized with supportive services era (p=0.04). Results suggest that centralizing youth-specific care and expanding youth services can improve retention in HIV care. These system changes should be considered when resources allow.

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

“…We also present data on linkage from HIV testing to enrolment in HIV care. Few studies are able to capture linkage from HIV testing to enrolment in care because longitudinal data are often missing at this step [11,13,38]. Our results show a high percentage of adolescents link to care after HIV testing, 86% in our study linked compared to 62 and 63% in two studies in similar settings [39,40].…”

Retention in Early Care at an HIV Outpatient Clinic in Rio de Janeiro, Brazil, 2000–2013

“…HIV-related stigma has been found to play a role in poor ART adherence and nondisclosure of HIV status among young adults (50,51), and may also explain why younger HIV-infected persons experience poor retention in early care at INI. Case management, peer-patient navigation systems and co-located services that recognize the unique needs of younger HIV-infected persons are promising models to address age-specific barriers to retention in early care (52–54). …”

Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

“…Among 174 HIV-infected youth, appointment attendance improved significantly after introduction of individualized case management focusing on increasing self-efficacy and developing group activities to improve support networks (195). In a cohort study of 61 young gay men who were newly diagnosed or in intermittent care, intensive case management, including initially weekly and then monthly meetings, also improved attendance to medical visits, and more intervention visits were associated with increased likelihood of ART prescription (196).…”