title: Linkage to and retention in care following healthcare transition from pediatric to adult HIV care.
abstract: Outcomes following healthcare transition (HCT) from pediatric to adult HIV care are not well described. We sought to describe clinical outcomes following HCT within our institution among young adults with behavioral-acquired (N = 31) and perinatally-acquired (N = 19) HIV. We conducted a retrospective cohort study among HIV-infected adults who attempted transition from pediatric to adult HIV care within our institution. The primary end point was retention in care, defined as the completion of at least two visits over 12 months following linkage to adult care. Additional end points include time to linkage to adult care, and changes in CD4 + T cell count and HIV RNA across time. Outcomes were compared between perinatal and behavioral HIV cohorts. Binary data were analyzed using the Fisher exact test and continuous data were analyzed using the Mann-Whitney test. Forty-three (86%) of 50 patients were successfully linked to adult care. The median time to linkage was 98 days. Fifty percent of patients achieved full retention in care at 12 months post-linkage. Though those with behavioral-acquired HIV attempted transfer at an older age, the groups did not differ in rates of linkage and retention in adult care. CD4 + T cell counts and rates of viral suppression did not differ between pre- and post-HCT periods. Despite high rates of successful linkage to adult care in our study population, rates of retention in adult HIV care following HCT were low. These results imply that challenges remain in the adult HIV care setting toward improving the HCT process.
authors.affiliation: a Institute of Human Virology , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ryscavage
authors.affiliation: a Institute of Human Virology , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Macharia
authors.affiliation: a Institute of Human Virology , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Devang
authors.initials: D
authors.lastname: Patel
authors.affiliation: a Institute of Human Virology , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Palmeiro
authors.affiliation: b Division of Pediatrics , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Tepper
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D010347:Patient Care Planning; D012189:Retrospective Studies; D060305:Transition to Adult Care; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; adolescent; healthcare transition; young adult