Improving Engagement and Retention in Adult Care Settings for Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Youth Living with HIV: Recommendations for Health Care Providers

R, Greifinger; Batchelor, Michelle; Fair, Cynthia D.

doi:10.1080/19359705.2013.739533

Cited by 8 publications

(4 citation statements)

References 27 publications

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“…Consistent with other studies, this study supports evidence that substance usage causes poor compliance to taking ART drugs [ 71 ]. Moreover, it is also known that patients in HIV care often are marginalized and do encounter stigma and discrimination, factors that contribute to poor engagement with HIV care services [ 72 – 75 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Kebede¹,

Mwanri

Ward

et al. 2021

Infect Dis Poverty

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Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Section: Discussionmentioning

confidence: 99%

Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Kebede¹,

Mwanri

Ward

et al. 2021

Infect Dis Poverty

View full text Add to dashboard Cite

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“…It is also possible that some of the TF youth sampled were unable to obtain gender affirmation services at the same clinic where they receive HIV care. Accessing care in multiple locations may prove too burdensome for youth who already face a number of psychosocial and structural obstacles to healthcare engagement [77], leading some youth to further prioritize medical gender affirmation care over HIV treatment. Additional research is needed to replicate this finding and to understand gender affirmation alongside HIV care, including implementation and evaluation of models of co-located service delivery [31].…”

Section: Discussionmentioning

confidence: 99%

Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

et al. 2017

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In the U.S., transgender and other gender minority (TG) youth are an at-risk group understudied in HIV prevention and treatment. This study sought to characterize the HIV prevention and care continua in a diverse sample of 181 sexually-active TG ages 16–24 years (mean age = 20.7 years; 76.8% trans feminine; 69.1% youth of color) recruited July–December 2015 in 14 U.S. cities. Overall, 30.9% reported living with HIV, of which 71.4% were on antiretroviral therapy (ART) and 55.0% were medication adherent; 65.6% were known to be virally suppressed. In multivariable models, medical gender affirmation was associated with lower odds of viral suppression. Medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments. Among at-risk TG youth not living with HIV, only 8.2% had accessed pre-exposure prophylaxis (PrEP). Early biobehavioral prevention and treatment interventions are needed for TG youth.

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“…Patients with HCV co-infection, homosexual contact or injecting drug use as the mode of HIV exposure were associated with a higher risk of LTFU. These populations are often marginalized and faced with stigma and discrimination, subsequently impacting on their engagement with health services 49-52 .…”

Section: Discussionmentioning

confidence: 99%

Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

Mata

Nguyen

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction Over time there has been substantial improvement in antiretroviral treatment (ART) programmes, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia. Methods Analysis included HIV-positive adults initiating ART in 2003-2013 at seven ART programmes in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results A total of 8,305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3%(2.9-6.1%) in 2003-05 to 8.1%(7.1-9.2%) in 2006-09, then decreased to 6.7%(5.9-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2%(4.5-8.2%) in 2003-05 to 3.3%(2.8-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared to 2006-09 (adjusted subhazard ratio=0.73, 0.69-0.99). Conclusions LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years while mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.

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Improving Engagement and Retention in Adult Care Settings for Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Youth Living with HIV: Recommendations for Health Care Providers

Cited by 8 publications

References 27 publications

Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

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