title: The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth.
abstract: Limited data exist on how structures of care impact retention among youth living with HIV (YLHIV). We describe the availability of youth-friendly structures of care within HIV Research Network (HIVRN) clinics and examine their association with retention in HIV care. Data from 680 15- to 24-year-old YLHIV receiving care at 7 adult and 5 pediatric clinics in 2011 were included in the analysis. The primary outcome was retention in care, defined as completing ≥2 primary HIV care visits ≥90 days apart in a 12-month period. Sites were surveyed to assess the availability of clinic structures defined a priori as 'youth-friendly'. Univariate and multivariable logistic regression models assessed structures associated with retention in care. Among 680 YLHIV, 85% were retained. Nearly half (48%) of the 680 YLHIV attended clinics with youth-friendly waiting areas, 36% attended clinics with evening hours, 73% attended clinics with adolescent health-trained providers, 87% could email or text message providers, and 73% could schedule a routine appointment within 2 weeks. Adjusting for demographic and clinical factors, YLHIV were more likely to be retained in care at clinics with a youth-friendly waiting area (AOR 2.47, 95% CI [1.11-5.52]), evening clinic hours (AOR 1.94; 95% CI [1.13-3.33]), and providers with adolescent health training (AOR 1.98; 95% CI [1.01-3.86]). Youth-friendly structures of care impact retention in care among YLHIV. Further investigations are needed to determine how to effectively implement youth-friendly strategies across clinical settings where YLHIV receive care.
authors.affiliation: 1 Divisions of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine , Baltimore, Maryland.
authors.forename: Lana
authors.initials: L
authors.lastname: Lee
authors.affiliation: 2 Department of Infectious Diseases, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.affiliation: 3 Department of Infectious Diseases, St. Jude Children's Research Hospital , Memphis, Tennessee.
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.affiliation: 4 Division of General Pediatrics, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: Rutstein
authors.affiliation: 5 Divisions of Infectious Diseases, Johns Hopkins School of Medicine , Baltimore, Maryland.
authors.forename: Kelly
authors.initials: K
authors.lastname: Gebo
authors.affiliation: 5 Divisions of Infectious Diseases, Johns Hopkins School of Medicine , Baltimore, Maryland.
authors.forename: Jeanne C
authors.initials: JC
authors.lastname: Keruly
authors.affiliation: 5 Divisions of Infectious Diseases, Johns Hopkins School of Medicine , Baltimore, Maryland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: 6 Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Ank E
authors.initials: AE
authors.lastname: Nijhawan
authors.affiliation: 5 Divisions of Infectious Diseases, Johns Hopkins School of Medicine , Baltimore, Maryland.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D016497:Adolescent Health Services / Q000458:organization & administration*; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D003266:Continuity of Patient Care / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D060145:Text Messaging; D055815:Young Adult