Healthcare Transition Outcomes Among Young Adults With Perinatally Acquired Human Immunodeficiency Virus Infection in the United States.
adult healthcare
perinatal HIV infection
self-manage
social support
transition
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
24 06 2020
24 06 2020
Historique:
received:
20
05
2019
accepted:
02
08
2019
pubmed:
5
10
2019
medline:
13
3
2021
entrez:
5
10
2019
Statut:
ppublish
Résumé
Young adults with perinatally acquired HIV (YPHIVs) living in the United States are transitioning to adult clinical care, yet there is little information on factors that affect transition outcomes. YPHIVs aged ≥18 years in the Pediatric HIV/AIDS Cohort Study (PHACS) AMP Up cohort approaching or having completed transition from pediatric to adult healthcare were included. Demographic and clinical characteristics and self-reported ability to self-manage healthcare were compared by transition status, and multivariable logistic regression models examined factors associated with satisfaction with, and retention in, adult clinical care (clinic visit within the previous 6 months). Most of the 455 YPHIVs, regardless of transition status, reported satisfaction with their clinic and care provider, but many reported antiretroviral medication nonadherence. Of the 124 YPHIVs who had transitioned, 56% had periods of unsuppressed HIV-1 RNA in the year before transition. Those who had transitioned were more likely to report high ability to self-manage their healthcare (ability to manage ≥7 of 8 skills) than those not transitioned. High self-management was associated with retention after transition (odds ratio, 3.40; 95% confidence interval, 1.33-9.12). Higher perceived emotional social support was also associated with retention. Older age at transition was associated with greater satisfaction with provider and clinic. YPHIVs have positive associations with their clinical care around the time of their transition to adult care, but unsuppressed viral load and suboptimal adherence are a concern. Strengthening skills that increase ability to self-manage care and enhance social support may increase retention in care and improve clinical health.
Sections du résumé
BACKGROUND
Young adults with perinatally acquired HIV (YPHIVs) living in the United States are transitioning to adult clinical care, yet there is little information on factors that affect transition outcomes.
METHODS
YPHIVs aged ≥18 years in the Pediatric HIV/AIDS Cohort Study (PHACS) AMP Up cohort approaching or having completed transition from pediatric to adult healthcare were included. Demographic and clinical characteristics and self-reported ability to self-manage healthcare were compared by transition status, and multivariable logistic regression models examined factors associated with satisfaction with, and retention in, adult clinical care (clinic visit within the previous 6 months).
RESULTS
Most of the 455 YPHIVs, regardless of transition status, reported satisfaction with their clinic and care provider, but many reported antiretroviral medication nonadherence. Of the 124 YPHIVs who had transitioned, 56% had periods of unsuppressed HIV-1 RNA in the year before transition. Those who had transitioned were more likely to report high ability to self-manage their healthcare (ability to manage ≥7 of 8 skills) than those not transitioned. High self-management was associated with retention after transition (odds ratio, 3.40; 95% confidence interval, 1.33-9.12). Higher perceived emotional social support was also associated with retention. Older age at transition was associated with greater satisfaction with provider and clinic.
CONCLUSIONS
YPHIVs have positive associations with their clinical care around the time of their transition to adult care, but unsuppressed viral load and suboptimal adherence are a concern. Strengthening skills that increase ability to self-manage care and enhance social support may increase retention in care and improve clinical health.
Identifiants
pubmed: 31584617
pii: 5550320
doi: 10.1093/cid/ciz747
pmc: PMC7312217
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
133-141Subventions
Organisme : NICHD NIH HHS
ID : U01 HD052102
Pays : United States
Investigateurs
Ram Yogev
(R)
Margaret Ann Sanders
(MA)
Kathleen Malee
(K)
Yoonsun Pyun
(Y)
William Shearer
(W)
Mary Paul
(M)
Norma Cooper
(N)
Lynnette Harris
(L)
Murli Purswani
(M)
Mahboobullah Mirza Baig
(MM)
Alma Villegas
(A)
Ana Puga
(A)
Sandra Navarro
(S)
Patricia A Garvie
(PA)
James Blood
(J)
Sandra K Burchett
(SK)
Nancy Karthas
(N)
Betsy Kammerer
(B)
Andrew Wiznia
(A)
Marlene Burey
(M)
Ray Shaw
(R)
Raphaelle Auguste
(R)
Arry Dieudonne
(A)
Linda Bettica
(L)
Juliette Johnson
(J)
Janet S Chen
(JS)
Maria Garcia Bulkley
(MG)
Taesha White
(T)
Mitzie Grant
(M)
Katherine Knapp
(K)
Kim Allison
(K)
Megan Wilkins
(M)
Jamie Russell-Bell
(J)
Midnela Acevedo-Flores
(M)
Heida Rios
(H)
Vivian Olivera
(V)
Margarita Silio
(M)
Medea Gabriel
(M)
Patricia Sirois
(P)
Stephen A Spector
(SA)
Kim Norris
(K)
Sharon Nichols
(S)
Elizabeth McFarland
(E)
Emily Barr
(E)
Carrie Glenny
(C)
Jennifer Dunn
(J)
Gwendolyn Scott
(G)
Grace Alvarez
(G)
Gabriel Fernandez
(G)
Anai Cuadra
(A)
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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