title: Predictors of highly active antiretroviral therapy utilization for behaviorally HIV-1-infected youth: impact of adult versus pediatric clinical care site.
abstract: OBJECTIVE
  We evaluated highly active antiretroviral therapy (HAART) utilization in youth infected with HIV through risk behaviors who met treatment criteria for HAART. We assessed the impact of receiving care at an adult or pediatric HIV clinical site on initiation and discontinuation of the first HAART regimen in behaviorally infected youth (BIY).
  
  
  METHODS
  This was a retrospective analysis of treatment-naive BIY, aged 12-24 years, who enrolled in the HIV Research Network between 2002 and 2008 and who met criteria for HAART. The outcomes were time from meeting criteria to initiation of HAART and time to discontinuation of the first HAART regimen. Analyses were conducted using Cox proportional hazards regression.
  
  
  RESULTS
  Of 287 treatment-eligible youth, 198 (69%) received HAART; of these 198 youth, 58 (29.3%) subsequently discontinued HAART. In multivariable analyses, there was no significant difference in the time between meeting treatment criteria and initiating HAART for BIY followed at adult or pediatric HIV clinical sites. However, BIY followed at adult sites discontinued HAART sooner than BIY followed at pediatric HIV clinical sites (adjusted hazard ratio [AHR]: 3.19 [1.26-8.06]).
  
  
  CONCLUSIONS
  Two-thirds of treatment-eligible BIY in the HIV Research Network cohort initiated HAART; however, one-third who initiated HAART discontinued it during the study period. Identifying factors associated with earlier HAART initiation and sustainability can inform interventions to enhance HAART utilization among treatment-eligible youth. The finding of earlier HAART discontinuation for youth at adult care sites deserves further study.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA. ageorg10@jhmi.edu
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ellen
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: Richard
authors.initials: R
authors.lastname: Rutstein
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Robert
authors.initials: R
authors.lastname: Warford
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Spector
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D010372:Pediatrics; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012309:Risk-Taking; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents