title: Impact of a youth-friendly HIV clinic: 10 years of adolescent outcomes in Port-au-Prince, Haiti.
abstract: Adolescents account for over 40% of new HIV infections in Haiti. This analysis compares outcomes among HIV-positive adolescents before and after implementation of an adolescent HIV clinic in Port-au-Prince, Haiti.
  
  
  
  We conducted a cohort study using programmatic data among HIV-positive adolescents aged 13 to 19. Data from 41,218 adolescents who were HIV tested from January 2003 to December 2012 were included. Outcomes across the HIV care cascade were assessed before and after implementation of an adolescent clinic (2009), including HIV testing, enrolment in care, assessment for antiretroviral therapy (ART) eligibility, ART initiation and 12-month retention. Pre-ART outcomes were assessed 12 months after HIV testing. Factors associated with pre-ART and ART attrition were identified through multivariable competing risk and Cox proportional hazards regression modelling.
  
  
  
  Cumulatively, 1672 (4.1%) adolescents tested HIV positive (80% female, median age 16 years). Retention by cascade step comparing pre- and post-clinic included the following: 86% versus 87% of patients enrolled in care, 61% versus 79% were assessed for ART eligibility, 85% versus 92% initiated ART and 68% versus 66% were retained 12 months after ART initiation. Pre-ART attrition decreased from 61% pre-clinic to 50% post-clinic (p<0.001). Pre-ART attrition was associated with being female (sub-distributional hazard ratio (sHR): 1.59; CI: 1.31-1.93), syphilis diagnosis (sHR: 1.47; CI: 1.16-1.85) and slum residence (sHR: 0.84; CI: 0.72-0.97). ART attrition was associated with syphilis diagnosis (hazard ratio (HR): 2.23; CI: 1.35-3.68) and CD4 <50 cells/µL (HR: 1.88; CI: 1.15-3.06).
  
  
  
  Implementation of a youth-friendly adolescent clinic improved retention in HIV care among adolescents, particularly in the assessment of ART eligibility and ART initiation. Additional interventions are needed to improve retention among pre-ART patients and support long-term retention among ART patients.
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; lir2020@med.cornell.edu.
authors.forename: Lindsey K
authors.initials: LK
authors.lastname: Reif
authors.affiliation: Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bertrand
authors.affiliation: Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Charles
authors.initials: C
authors.lastname: Benedict
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Lamb
authors.affiliation: Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rouzier
authors.affiliation: Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Rose
authors.initials: R
authors.lastname: Verdier
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Warren D
authors.initials: WD
authors.lastname: Johnson
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, NY, USA.|Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.affiliation: Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, NY, USA.|Division of Hospital Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNairy
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004608:Eligibility Determination; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D006205:Haiti; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D013587:Syphilis; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; adolescent; attrition; epidemiology; retention; youth