title: Aging and loss to follow-up among youth living with human immunodeficiency virus in the HIV Research Network.
abstract: OBJECTIVE
  In the United States, 21 years is a critical age of legal and social transition, with changes in social programs such as public insurance coverage. Human immunodeficiency virus (HIV)-infected youth have lower adherence to care and medications and may be at risk of loss to follow-up (LTFU) at this benchmark age. We evaluated LTFU after the 22nd birthday for HIV-infected youth engaged in care. LTFU was defined as having no primary HIV visits in the year after the 22nd birthday.
  
  
  METHODS
  All HIV-infected 21-year-olds engaged in care (2002-2011) at the HIV Research Network clinics were included. We assessed the proportion LTFU and used multivariable logistic regression to evaluate demographic and clinical characteristics associated with LTFU after the 22nd birthday. We compared LTFU at other age transitions during the adolescent/young adult years.
  
  
  RESULTS
  Six hundred forty-seven 21-year-olds were engaged in care; 91 (19.8%) were LTFU in the year after turning 22 years. Receiving care at an adult versus pediatric HIV clinic (adjusted odds ratio [AOR], 2.91; 95% confidence interval [CI], 1.42-5.93), having fewer than four primary HIV visits/year (AOR, 2.72; 95% CI, 1.67-4.42), and antiretroviral therapy prescription (AOR, .50; 95% CI, .41-.60) were independently associated with LTFU. LTFU was prevalent at each age transition, with factors associated with LTFU similar to that identified for 21-year-olds.
  
  
  CONCLUSIONS
  Although 19.8% of 21-year-olds at the HIV Research Network sites were LTFU after their 22nd birthday, significant proportions of youth of all ages were LTFU. Fewer than four primary HIV care visits/year, receiving care at adult clinics and not prescribed antiretroviral therapy, were associated with LTFU and may inform targeted interventions to reduce LTFU for these vulnerable patients.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: ageorg10@jhmi.edu.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Lana
authors.initials: L
authors.lastname: Lee
authors.affiliation: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland.
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Cindy
authors.initials: C
authors.lastname: Voss
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Keri N
authors.initials: KN
authors.lastname: Althoff
authors.affiliation: Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: Rutstein
authors.affiliation: Department of Clinical Medicine, University of California San Diego Medical Center, San Diego, California.
authors.forename: W Christopher
authors.initials: WC
authors.lastname: Mathews
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas Texas.
authors.forename: Ank
authors.initials: A
authors.lastname: Nijhawan
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000375:Aging / Q000502:physiology*; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012189:Retrospective Studies; D012737:Sex Factors; D060305:Transition to Adult Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Adolescents; Attrition; Care; HIV Research Network; Loss to follow-up; Young adults; Youth