Program aimed at addressing age-related disparities in HIV care
By Molly Walker,
May 22, 2017
Around three-quarters of HIV-positive youth were linked with healthcare resources within six weeks of the implementation of a national strategy to improve HIV care in this population, researchers found.
Programs that were started to identify youth living with HIV and improve their access to care got from 70% to 77% of HIV-positive youths to a medical visit within their first 42 days of testing, reported J. Dennis Fortenberry, MD, of Indiana University School of Medicine, and colleagues.
Of these young people, nearly all (86% to 89%) received a second medical visit within three months, thus continuing their care, the authors wrote in JAMA Pediatrics.
They argued that there are “age-related disparities” in care between youth and adults living with HIV. Less than half of youths ages 13 to 24 years are aware of their diagnosis compared to 84% of adults. Compared to 77% of adults in care, only 61% of youth in care achieve viral suppression, they said.
The authors characterized age itself as “an important contribution to care continuum disparities” because “newly diagnosed young people have limited experience with healthcare systems and face legal or procedural barriers in obtaining care,” they wrote.
They described an integrated approach to the National HIV/AIDS Strategy: Updated to 2020. It was implemented by the Adolescent Medicine Trials Network for HIV/AIDS Interventions, a national youth-focused HIV research network supported by the National Institute of Child Health and Human Development, the National Institute of Mental Health, and the National Institute for Drug Abuse. The research program contained seven elements, including deployment of a full-time linkage to care coordinators, developing formal referral to care networks, and delivering local linkage to care partnerships.
There were two protocol sites; one was the Strategic Multisite Initiative for the Identification, Linkage to and Engagement in Care of Youth With Undiagnosed HIV (SMILE 1), which was started in 2009 in 15 Adolescent Medicine Trials Network sites in the U.S. and Puerto Rico. SMILE 2 was implemented in 2012 in eight existing sites and five sites replacing those not refunded. There was also an additional component added to address racial/ethnic disparities, the Project for the Enhancement and Alignment of the Continuum of Care for HIV-Infected Youth (PEACOC), which was supported by the Secretary’s Minority AIDS Initiative Fund.
Overall, 3,896 youths were referred to either of these programs between 2009 and 2016 — a little less than 10% of whom were children under 18 years of age. A larger portion of referrals came from SMILE 2/PEACOC site than SMILE 1 (57% vs 43%). Viral load at referral was 15,474 copies/mL in SMILE 1 compared to 20,089 copies/mL in SMILE 2.
Deploying full-time linkage to care coordinators was a goal of the National HIV/AIDS Strategy, and the authors said that they showed “specifically trained linkage to care coordinators were more effective at linkage to care than others and more effective in helping youths remain in care, especially in the context of public health authority.” They added that “community mobilization approaches” could be used to implement structural changes in the entire continuum of care and that these disparities in care could be “systematically addressed.”
The authors concluded this intervention is “feasible, potentially effective and may offer a sustainable approach” in combatting the age-related disparity of health outcomes for HIV-infected youth compared to adults.
Source Reference: Fortenberry JD, et al “Implementation of an integrated approach to the National HIV/AIDS Strategy for improving Human Immunodeficiency Virus care for youths” JAMA Pediatr 2017; DOI: 10.1001/jamapediatrics.2017.0454.