Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.
Clin Infect Dis. 2023 Apr 3;76(7):1218-1224. doi: 10.1093/cid/ciac904.
Healthcare transition from pediatric to adult-oriented clinical settings is often viewed as a high-risk time for care disengagement. However, there is a paucity of prospective, longitudinal research documenting human immunodeficiency virus (HIV) care outcomes after healthcare transition.
We conducted a prospective, observational cohort study of healthcare transition among youth enrolled at an HIV care center in Atlanta, Georgia. Pediatric clinic patients (average age, 24 years) were enrolled up to 3 months before the expected transition and were followed up to determine linkage, retention, and viral suppression in adult care through electronic medical record abstractions at the baseline and at 6, 12, 18, and 24 months.
The majority of our cohort (n = 70) was male (88.6%) and black (92.9%) and acquired HIV horizontally (80%). Most of our cohort was linked to adult care by 12 months (84%) after enrollment. Of those who linked to adult care by 12 months, retention rates were 86% (95% confidence interval, 78%-94%) at 6 months, 76% (66%-86%) at 12 months, and 66% (55%-78%) at 18 and 24 months. Once in adult care, the proportion with viral suppression was stable (73% at baseline and 74%, 77%, 67%, and 78% at 6, 12, 18, and 24 months, respectively).
Although most youth successfully linked to adult care, retention rates decreased over the 24-month follow-up period. Rates of viral suppression were stable for those who remained in care. Strategies to support retention in adult care will be critical to optimizing this transition for youth with HIV.
医疗保健从儿科向成人临床环境的转变通常被视为护理脱离的高风险时期。然而，缺乏前瞻性、纵向研究来记录人类免疫缺陷病毒（HIV）在医疗保健转变后的护理结果。
我们在佐治亚州亚特兰大的一个 HIV 护理中心进行了一项前瞻性、观察性队列研究，以研究青年的医疗保健转变。儿科诊所患者（平均年龄 24 岁）在预计转变前最多提前 3 个月入组，并通过电子病历摘录在基线和 6、12、18 和 24 个月时确定在成人护理中的联系、保留和病毒抑制情况。
我们的队列大多数（n=70）为男性（88.6%）和黑人（92.9%），并且经水平途径感染 HIV（80%）。我们的队列中大多数在入组后 12 个月内（84%）与成人护理建立联系。在 12 个月内与成人护理建立联系的人群中，6 个月时的保留率为 86%（95%置信区间，78%-94%），12 个月时为 76%（66%-86%），18 个月和 24 个月时分别为 66%（55%-78%）。一旦进入成人护理，病毒抑制比例保持稳定（基线时为 73%，6、12、18 和 24 个月时分别为 74%、77%、67%和 78%）。
尽管大多数青年成功与成人护理建立联系，但在 24 个月的随访期间，保留率下降。在继续接受护理的人群中，病毒抑制率保持稳定。支持成人护理保留的策略对于优化 HIV 青年的这种转变至关重要。
