Youth with HIV have an increased risk for being lost to
follow-up after the age of 18 years, according to data from a poster presented
at the XIX International AIDS Conference.
Given the challenges of young adulthood, youth
with HIV infection do appear to be at risk for falling out of care,
Allison Agwu, MD, assistant professor of pediatrics at Johns Hopkins
Medical Institutions, told Infectious Disease News. These youth
may be seen at adult or pediatric/adolescent clinics, and there may be factors
intrinsic to the different clinical programs at those sites that may impact
whether or not they stay in care.
Agwu and colleagues analyzed factors associated with
loss to follow-up among those who turned 18 years of age from 2002 to 2008. The
adolescents with HIV were receiving care at one of 13 clinics in the HIV
Research Network cohort. This study included 120 adolescents who were receiving
care before aged 18 years.
Twelve of the 120 adolescents had no outpatient
follow-up after their 18th birthday, but none of the adolescents lost to
follow-up died. Gender, insurance status, CD4 count and ART prescription did
not differ between adolescents lost to follow-up and those remaining in care.
After adjusting for gender, race/ethnicity, outpatient visits, HIV acquisition
risk and insurance status, receiving care at an adult site in adolescence was
associated with loss to follow-up care.
As providers caring for this population, we need
to be creative about the mechanisms to engage and maintain youth in care, such
as text messaging and flexible appointment hours, among others, Agwu
said. Importantly, we need to pay attention and have programs in place to
follow, track and re-engage when they do fall out of care.
Agwu A. #MOPE61. Presented at: XIX International AIDS Conference;
July 22-27, 2012; Washington, D.C.
Dr. Agwu reports no relevant financial disclosures.