Title

Ability to manage health after transition to adult care is associated with retention in care among young adults with perinatal HIV infection

Presenter

Katherine Tassiopoulos

Authors

K. Tassiopoulos¹, Y. Huo², K. Patel¹, S. Nichols³, D. Kacanek², S. Allison⁴, M. Paul⁵, S. Siminski⁶, C. Mellins⁷, The Pediatric HIV/AIDS Cohort Study (PHACS)

Institutions

¹Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, United States, ²Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, United States, ³University of California San Diego, Department of Neurosciences, La Jolla, United States, ⁴National Institute of Mental Health, Division of AIDS Research, Bethesda, United States, ⁵Baylor College of Medicine, Pediatrics, Houston, United States, ⁶Frontier Science & Technology Research, Amherst, United States, ⁷Columbia University, Psychiatry and Sociomedical Sciences, New York, United States

Background: Perinatally HIV-infected (PHIV) adolescents are reaching adulthood and transitioning from pediatric to adult health care in increasing numbers. Yet there is little research on satisfaction with and retention in care after this transition.
Methods: The PHACS (Pediatric HIV/AIDS Cohort Study) AMP Up protocol is enrolling PHIV adults 18 years and older (including targeted enrollment of mothers) for long-term study of clinical and behavioral health. Participants complete an annual online survey on sociodemographics, behaviors, quality of life, and health care, including 8 questions on the ability to manage different aspects of one''s own health. This analysis of entry visit data focused on the 124 out of 455 AMP Up participants (27%) enrolled to-date who had completed the transition to adult care. Multivariable logistic regression models evaluated associations of several factors with satisfaction with adult care provider/clinic (very satisfied/satisfied vs. dissatisfied/very dissatisfied) and retention in care (having had a health care visit within past 6 months).
Results: The average age at study entry was 26.6 years; 52% are Black or African-American, 46% Hispanic, and 71% female. The average age at transition was 21.7 years (range=15.9, 27.4). Older age at transition was associated with greater satisfaction with adult care provider (per year increase in age, OR =1.36, 95% C.I.=1.03, 1.84; p-value=0.04) and clinic (OR=1.30, 95% C.I.=0.98, 1.78; p-value=0.08). Young adults who reported greater ability to manage their care (yes to ≥7 of 8 questions) were more likely to have had a recent health care visit. Several individual indicators of health care self-management (ability to make their own appointments, fill prescriptions, and state their CD4 or viral load measures) were strongly associated with having a recent health care visit (Figure). Other factors (involvement in choosing adult care provider, depression, availability of supportive services at clinic) were not associated with the outcomes.
Conclusions: Young PHIV adults with greater ability to manage their health after their transition to adult care are more likely to have had a recent health care visit. This finding suggests that providers can assist their patients'' successful transition by helping them develop skills to manage their health prior to this transition.

[Associations between Ability to Manage Health Care and Visit to Adult Care Clinic]