title: Rates and correlates of antiretroviral therapy use and virologic suppression among perinatally and behaviorally HIV-infected youth linked to care in the United States.
abstract: OBJECTIVE
  To measure rates of antiretroviral therapy (ART) use and virologic suppression among perinatally HIV-infected youth (PIY) and behaviorally HIV-infected youth (BIY) linked to care in the United States and examine the effects of demographic, biomedical, and psychosocial factors on those rates.
  
  
  METHODS
  Between 2009 and 2012, 649 PIY and 1547 BIY in 20 Adolescent Medicine Trials Network for HIV/AIDS Interventions sites completed cross-sectional surveys through audio computer-assisted self-interviews. Viral load data were collected from chart abstraction or blood draw.
  
  
  RESULTS
  Overall 82.4% of PIY and 49.1% of BIY reported current ART use. Only 37.0% of PIY and 27.1% of BIY were virologically suppressed. Virologic suppression rates did not vary as a function of time since HIV diagnosis in either group. Consistent HIV care and no current substance abuse were significant correlates of ART use among PIY. These variables and non-African American race were some factors associated with virologic suppression for PIY [odds ratios (ORs) P < 0.05]. Among BIY, older age, heterosexuals, employment, and education were significantly related to ART use (ORs: P < 0.05); suppression was related to ART use ≥6 months, ≥90% ART adherence, and consistent HIV care (ORs: P < 0.05). Nearly 75% (n = 498) of nonsuppressed youth reported unprotected sex in the past 3 months.
  
  
  CONCLUSIONS
  There are continued challenges with successfully treating youth even once diagnosed and linked to HIV care. Strategies targeting barriers to ART access, use, and virologic suppression are needed to optimize the impact of the "Treatment as Prevention" paradigm among PIY and BIY.
authors.affiliation: *Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, MD; †Department of Preventive Medicine and Department of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL; ‡Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY; §Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI; ‖Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health, Bethesda, MD; ¶Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL; and #Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Shoshana Y
authors.initials: SY
authors.lastname: Kahana
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Fernandez
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Wilson
authors.forename: Jose A
authors.initials: JA
authors.lastname: Bauermeister
authors.forename: Sonia
authors.initials: S
authors.lastname: Lee
authors.forename: Craig M
authors.initials: CM
authors.lastname: Wilson
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Hightow-Weidman
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents