Factors and Outcomes Associated With Viral Suppression Trajectory Group Membership Among Youth Transitioning From Pediatric to Adult HIV Care

Abstract

Purpose: Youth experiencing healthcare transition (HCT) from pediatric to adult HIV care are at risk for poor viral suppression (VS). We have a limited understanding of VS trajectory groups (VSTGs) pre- and post-HCT and factors associated with these trajectories. Methods: We analyzed Philadelphia HIV surveillance data of youth diagnosed with HIV at least 2 years pre-HCT. We used group-based trajectory analysis to characterize VS trends pre- and post-HCT. We compared baseline sociodemographic characteristics across the different VSTGs and care continuum outcomes in the year post-HCT. Generalized estimating equations evaluated the association between VSTG and HIV care continuum outcomes measured 2 years post-HCT. Results: Between 2012 and 2019, 232 eligible youth underwent HCT: 69.4% were aged 24–25, 75.4% male, and 76.7% non–Hispanic Black. Three VSTGs were identified: low (30.6%), increasing (26.7%), and high probability (42.7%) for VS. Younger age was associated with high-probability VSTG membership: 59.2% of those aged 18–23 versus 35.4% of those aged 24–25 were in the high-probability VSTG (p < .001). Demographics found to be associated with linkage to care post-HCT included younger age (p = .018), female sex at birth (p = .038), and perinatal acquisition (p = .012). Perinatal acquisition was also associated with retention in care in the year post-HCT (p = .029). For those transitioning between 2012 and 2018, those in the high-probability VSTG had greater odds of being retained (adjusted odds ratio 1.68, 95% confidence interval 1.03–2.71) and VS (adjusted odds ratio 6.95, interval 3.74–12.95) 2 years post-HCT, compared to those in the low VSTG. Discussion: We identified distinct VSTGs that informed long-term trends post-HCT. VSTG membership may allow for tailoring of appropriate HCT support.