Engagement in care among youth living with parenterally-acquired HIV infection in Romania

Abstract

Transition from adolescent to adult care can be challenging for youth living with HIV. We describe the level of engagement in care and its impact on HIV outcomes in a group of patients infected in early childhood and followed-up through adolescence (15-19 years) and young adulthood (20-24 years) by the same medical team. We conducted a cohort study of youth born between 1985-1993 and infected with HIV parenterally, followed at a single tertiary care centre. Individuals were followed from age 15 years or first clinic visit (whichever came last) until age 25 years or 30 Nov 2016 (whichever came first). A longitudinal continuum-of-care was constructed, categorizing individuals' status for each month between the ages of 15-25 years as: engaged in care (EIC); not in care (NIC: no clinic visits within past year); lost-to-follow-up (LTFU: NIC and did not return to clinic); or died. Those EIC were further subdivided by current CD4 count and viral load (VL). 545 individuals (52% male) were followed for 4775 person-years. 64 (12%) became LTFU and 27 (5%) died. At age 15, 92% were EIC, decreasing to 84% at age 20 and 74% at age 25. Of those EIC, HIV markers improved with age: 79% and 52% had a CD4≥200 cells/µl and VL<400 cps/ml at age 15; increasing to 86% and 73% at age 20 and 87% and 80% at age 25. 277 (55.5%) spent their entire adolescence EIC; this decreased to 202 (37%) for the years of young adulthood (p=0.0001). There were no observed demographic differences between those with continuous and intermittent engagement in care. We conclude that youth infected during early childhood tended to disengage from care, even when followed by the same medical team for a lengthy period of time. For those that did engage in care, HIV-related outcomes improved from adolescence through to adulthood.

Experiences of Caring for Adolescents Living with HIV (ALHIV): A Qualitative Interview with Caregivers

“…Such factors have stopped adolescents living with HIV from engaging themselves HIV care. [26][27][28][29] Disengagement of these adolescents living with HIV from care has resulted into issues related to their health like weight loss, and poor ART adherence. 30 This has resulted into continuous weight loss of ALHIV at every hospital visit.…”

HIV continuum of care: expanding scope beyond a cross-sectional view to include time analysis: a systematic review

“…Despite the well-established benefits of early entry to care, only a few articles provided estimates of the time of infection and thus of the time between infection and diagnosis and/or ART initiation [22][23][24]. Apart from studies that considered the transition probabilities as the percentage of individuals that pass to the next CoC stage among those participating to the previous one stage [21,35], one study analysed the CoC as a dynamic process with distinct states that individuals could enter and leave more than once during their lifetime [22]. These considerations can improve HIV health care programmes by identifying the CoC stages at which individuals are most likely to leave care.…”

“…These considerations can improve HIV health care programmes by identifying the CoC stages at which individuals are most likely to leave care. Another time-related aspect examined in three of the reviewed studies that could be of value, especially from a public health point of view, was the cumulative time spent in each CoC stage [21,34,35].…”