Predictors of retention in care among hiv and at risk youth
Download
1 / 24

Predictors of Retention in Care Among HIV and At-Risk Youth - PowerPoint PPT Presentation


  • 238 Views
  • Uploaded on

Predictors of Retention in Care Among HIV+ and At-Risk Youth. Sion Kim Harris, PhD Cathryn L. Samples, MD, MPH Peter Keenan, RN, C-PNP Durrell J. Fox, BS Maurice W. Melchiono, RN, MS, C-FNP Elizabeth R. Woods, MD, MPH Boston HAPPENS Program Participants

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Predictors of Retention in Care Among HIV and At-Risk Youth' - lynde


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Predictors of retention in care among hiv and at risk youth

Predictors of Retention in CareAmong HIV+ and At-Risk Youth

Sion Kim Harris, PhD

Cathryn L. Samples, MD, MPH

Peter Keenan, RN, C-PNP

Durrell J. Fox, BS

Maurice W. Melchiono, RN, MS, C-FNP

Elizabeth R. Woods, MD, MPH

Boston HAPPENS Program Participants

Children’s Hospital Boston, Harvard Medical School

Society for Adolescent Medicine Annual Meeting 2002


Study grant support
Study Grant Support

  • Special Projects of National Significance Program (SPNS) #BRH 970155-05-0, HRSA, DHHS

  • Leadership in Adolescent Health Project #5T 71 MC 00009-10, MCH Bureau, HRSA, DHHS

  • W.T. Grant Foundation

  • Children’s Hospital’s Aerosmith Fund for HIV Care and Prevention


Background
Background

  • At-risk youth are hard to engage and retain in care

  • Ancillary services such as outreach, case management, and mental health services believed to enhance retention in care


Study aims
Study Aims

  • Describe retention in care of youth clients of a comprehensive adolescent HIV care program (Boston HAPPENS Program)

  • Assess impact of outreach, case management, mental health services on likelihood of retention over time, adjusted for potential confounding factors


Program description
Program Description

  • Boston HIV Adolescent Provider and Peer Education Network for Services (HAPPENS)

  • Coordinated network of 8 agencies serving at-risk youth ages 12-24

  • Comprehensive care including HIV CTS, outreach, nurse case management, mental health services, and medical care


Study population
Study Population

  • HAPPENS clients seen during data collection period (4.5 years)

  • Clients excluded from analysis if had no more than two standard HIV counseling and testing visits


Data collection method
Data Collection Method

  • Standard forms used by all 10 SPNS programs

  • “Contact” form: used at client enrollment or street/phone contact to record demographic and HIV risk info, outreach services provided

  • “Intervention” form: used at each health visit to record health care, case management, mental health services provided


Data analyses method
Data Analyses Method

Survival analysis:

  • Retention measure

    • Number of days between first and last visits during data collection period

  • Censored cases

    • Clients with at least one visit during last program year


Key predictor variables
Key Predictor Variables

  • Number of outreach contacts

    Categories: 0, 1, >2 times

  • Number of mental health service visits

    Categories: 0, 1, >2 times

  • Number of case management visits

    Categories: 0, 1-2, >3 times


Other potential predictors

Age

Gender

Race/ethnicity

HIV status

Mental health system involvement

Homeless/runaway

Self-identified sexual orientation

Ever pregnant

Ever had STD

Any unprotected sex

Any survival sex, sex with HIV+ or injection drug using partner (high risk sex)

Any substance abuse, injection drug use, or needle-sharing

Other Potential Predictors

Client Demographic and HIV Risk Factors:


Other potential predictors cont d

Type of site of initial care

Multi-service outreach agency

Community health center

Hospital

Other Potential Predictors (cont’d)


Statistical tests
Statistical Tests

  • All analyses were gender-stratified

  • Descriptive analyses:

    • Kaplan-Meier survival curve analysis

  • Bivariate analyses:

    • Log-rank test to assess group differences in retention times


Statistical tests cont d
Statistical Tests (cont’d)

  • Multivariate Cox Proportional Hazards (PH) regression modeling

    • Variables related to retention at p<0.10 entered into model, including age, HIV status

    • Adjusted Hazard Ratio (AHR) and 95% CI

  • PROC SURVIVAL in SUDAAN® used to account for potential intra-cluster correlation within sites



Overall program retention
Overall Program Retention

  • Retention times ranged from 0-1406 days for males, 0-1577 for females

  • About two-thirds of clients returned for at least a second visit (males=64.3%, females=70.0%)

  • 25% in both gender groups retained for more than a year

  • 10% of males and 15% of females retained for more than two years


Probability of Retention Over Timeby Number of Outreach Contacts

MALES

FEMALES

>2 contacts*

Cum Probability of Retention

>2 contacts*

0

0

1

Number of days between first and last visits

Log-rank test: *p<0.001; ¥p=0.002


Probability of Retention Over Timeby Number of Mental Health Visits

MALES

FEMALES

>2 visits*

>2 visits*

Cum Probability of Retention

1

0

0

Number of days between first and last visits

Log-rank test: *p<0.001; ¥p=0.03


Probability of Retention Over Timeby Case Management Visits

MALES

FEMALES

>3 visits*

>3 visits*

Cum Probability of Retention

1-2

1-2

0

0

Number of days between first and last visits

Log-rank test: *p<0.001


Cox PH Modeling Results, Males

* Adjusted for age, HIV status, race/ethnicity, sexual orientation,

homelessness, MH-system involvement, and high risk sex behaviors


Cox PH Modeling Results, Females

* Adjusted for age, HIV status, race/ethnicity, sexual orientation, any

pregnancy, and any unprotected sex with males


Discussion
Discussion

  • Some hard-to-reach, at-risk youth can be retained in care, with intensive efforts

  • Increased outreach and case management associated with  retention (adjusted for client demographic and risk factors)

  • Mental health counseling related to retention of male clients


Study limitations
Study Limitations

  • HAPPENS clients may not be representative of all at-risk youth

  • Visits to providers outside of program not included

  • Variability in quality, completeness of data across sites

  • Cell sizes for some variables small


Study limitations cont d
Study Limitations (cont’d)

  • Other client and program factors related to retention unmeasured


Implications
Implications

  • Comprehensive services help retain at-risk youth in care

  • Ancillary services such as outreach, case management, mental health services need to be more consistently funded for all at-risk youth, not just HIV+


ad