By: Ed Susman
WASHINGTON, DC – When teenagers with HIV move from the paediatric environment to an adult facility, it appears they become at high risk for dropping out of treatment, researchers said at the 19th International AIDS Conference.
Of 120 adolescents/young adults who were followed from their 18th year of life, after their 17th birthday, 12 were lost to follow-up, according to Alison Agwu, MD, Pediatric Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland.
She tried to determine what the main reason was for the healthcare system to lose track of the children who were now adults and determined that the transition to an adult clinic from a paediatric facility made is 6 times more likely that the patient would be lost to follow-up (P =.002).
“We really don’t understand why the change in facility leads to disconnection with the healthcare system,” she said at her poster presentation on July 23. However, adolescents aged 17 to 19 years are a challenging group of patients, she noted in her poster.
The researchers from a consortium of 18 institutions in HIV Research Network were involved in the study; 13 of the clinics contributed data.
“Eighteen is a critical age of legal and social transition, as there are changes in insurance coverage and foster care,” said Dr. Agwu. “As a result, adolescents turning 18 years of age may be at a particularly high risk of falling out of care.”
The researchers evaluated loss to follow-up following the 18th birthday of HIV-infected adolescents engaged in care in the consortium clinics. About 58% of the 120 patients were men. Eighty-five percent of 108 patients who remained in care were black, as were 75% of those who dropped out. About 8% of the patients identified themselves as white and 4% were Hispanic. About 35% of the children acquired HIV through heterosexual contacts, 34% were perinatally infected, 25% were men who had sex with men.
Patients were eligible for the study if they were aged 17 years and were in care — defined as at least 1 CD4-positive cell count assessment, 1 viral load assessment, and 1 visit to a primary HIV provider during their 18th year of life.
Dr. Agwu noted that the study is limited in that the researchers assumed that if the patients fell out of care at 1 clinic and that clinic was unaware of the patients’ whereabouts that the patients did not seek or receive follow-up care at another clinic.
- MFP Wire Services