Griffith David C, Agwu Allison L
a Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore , USA.
b Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA.
AIDS Care. 2017 Oct;29(10):1205-1211. doi: 10.1080/09540121.2017.1290211. Epub 2017 Feb 13.
With the increasing proportion of youth living with human immunodeficiency virus (YLHIV) and the aging of the perinatally infected population, there is a need for clinical services that are "youth friendly" to address the multiple challenges YLHIV face in terms of engagement in care and maintenance of combination antiretroviral therapy (cART). Little is known about how and where YLHIV receive their care. Further, the impact of the care structure on engagement and retention outcomes for YLHIV is ill defined. In order to better classify how YLHIV receive care in the United States, we performed a review of published literature characterizing the structure and outcomes of care for YLHIV. Several key concepts emerged: 1. The majority of YLHIV (13-24 years old) are cared for at adult sites, 2. Clinics providing care to YLHIV are varied in terms of the services offered and the types of services offered can impact outcomes, 3. YLHIV cared for in adult clinical sites have poor retention and antiretroviral treatment initiation, and 4. YLHIV cared for at adult sites had poorer retention and cART outcomes compared to YLHIV cared for at pediatric sites. There were no studies identified that specifically examined "youth friendly" care for YLHIV within the context of adult clinical sites. The results of this review highlight disparities for YLHIV and the need for interventions to improve outcomes for YLHIV in the context of adult care.
随着感染人类免疫缺陷病毒的青年（YLHIV）比例不断增加以及围产期感染人群的老龄化，需要有“对青年友好”的临床服务来应对YLHIV在接受治疗和维持联合抗逆转录病毒疗法（cART）方面面临的多重挑战。对于YLHIV如何以及在哪里接受治疗知之甚少。此外，护理结构对YLHIV的参与度和留存率结果的影响尚不明确。为了更好地分类YLHIV在美国接受治疗的方式，我们对已发表的文献进行了综述，这些文献描述了YLHIV的护理结构和结果。出现了几个关键概念：1. 大多数YLHIV（13 - 24岁）在成人机构接受护理；2. 为YLHIV提供护理的诊所提供的服务各不相同，所提供的服务类型会影响结果；3. 在成人临床机构接受护理的YLHIV留存率低且抗逆转录病毒治疗启动率低；4. 与在儿科机构接受护理的YLHIV相比，在成人机构接受护理的YLHIV留存率和cART结果较差。没有发现专门研究在成人临床机构背景下对YLHIV的“对青年友好”护理的研究。该综述结果凸显了YLHIV的差异以及在成人护理背景下改善YLHIV结果的干预措施的必要性。
