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Adolescents with HIV need to be rapidly linked to specialist care to have best chances of sustaining engagement with HIV services
Michael Carter, 2016-06-14 07:00:00
diagnosed with HIV need to be rapidly incorporated into HIV care networks to
have the best chances of remaining in care in the long term, research from the
United States published in the June 1st edition of the Journal of Acquired Immune Deficiency
Worryingly, only 62% of newly diagnosed adolescents were
linked and engaged in care within 22 weeks of referral following their
diagnosis. However, adolescents with shorter intervals between diagnosis and
referral to HIV services, and then referral and linkage to care were more
likely to quickly engage with care and to stay in care.
demonstrates that the time interval between a newly diagnosed adolescent’s HIV
test and care referral and the time interval between care referral and first
medical visit (linkage to care) have concrete implications for long-term HIV
care engagement,” comment the investigators. “These data have quality of care
implications for HIV testing programs in that the speed with which HIV-positive
youth are referred for linkage has downstream implications for engagement.”
The HIV care
continuum has several stages, specifically diagnosis, referral to specialist care,
linkage to care, engagement with care, starting HIV therapy and viral
suppression. In the US, adolescents – people aged between 12 and 24 years
– have much poorer rates of engagement in HIV care compared to adults, and
consequently, only 6% of all adolescents living with HIV have an undetectable
viral load compared to approximately a third of adults.
wanted to see if longer time between HIV diagnosis and referral and linkage to
care had subsequent implications for later engagement with care for newly
collected data from 15 Adolescent Medicine Trials Network Clinic sites in 13
cities across the US and Puerto Rico. Each of these sites implemented the SMILE
programme in 2010, which was designed to boost adolescent engagement in the HIV
care continuum. SMILE used intensive case management to identify newly diagnosed adolescents, assess individual barriers to linkage to care and achieve personalised referral to specialist care services.
For the purposes
of the study, linkage to care was defined as an HIV-related medical appointment
within six weeks of referral following diagnosis. Engagement in care was a
second visit within 16 weeks of the initial visit.
During 32 months,
1799 newly diagnosed adolescents were referred to the SMILE programme. Of
these, 70% were linked to care and 89% of these individuals were engaged in
care. Therefore, only 62% of adolescents were linked and engaged with care.
The adolescents were
predominately male (80%), black (77%) and were in the men-who-have sex with men risk group (74%). The mean age was 21 years and two-thirds reported drug
use. Most (80%) were assigned an outreach worker.
Time from HIV
testing to initial referral (under one week vs. over one year) was associated
with higher chances of subsequent engagement with care (aHR = 2.91; 95% CI,
1.43-5.94) and also shorter time to engagement (aHR = 1.41; 95% CI, 1.11-1.79).
with shorter intervals between referral and linkage to care (under one week vs.
22-42 days) engaged in care faster (aHR = 2.90; 95% CI, 2.34-3.60) and were
more likely to remain engaged in care (aHR = 2.01; 95% CI, 1.04-3.89).
suggests that each newly diagnosed HIV-infected youth needs to be linked to
care as quickly as possible to facilitate more rapid engagement in care, access
to medications, and better long-term prognosis,” conclude the authors. “These
data should be used to build evidence and help construct a seamless continuum
of care for HIV-infected youth to help fulfill the goals outlined in the US
National HIV/AIDS Strategy.”