Predictors of retention in care among hiv and at risk youth
This presentation is the property of its rightful owner.
Sponsored Links
1 / 24

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


  • 190 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

Predictors of Retention in Care Among HIV+ and At-Risk Youth

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


Client characteristics by gender total n 1426

Client Characteristics by Gender(Total N=1426)


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


Predictors of retention in care among hiv and at risk youth

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


Predictors of retention in care among hiv and at risk youth

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


Predictors of retention in care among hiv and at risk youth

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


Predictors of retention in care among hiv and at risk youth

Cox PH Modeling Results, Males

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

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


Predictors of retention in care among hiv and at risk youth

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+


  • Login