PATTERNS OF RETENTION IN HIV CARE AND FACTORS ASSOCIATED WITH VIRAL SUPPRESSION IN YOUTH AND YOUNG ADULTS AGE 18-30 WITH HIV IN AN URBAN PRACTICE

Purpose: The burden of HIV-1 infection in the United States is disproportionately seen in youth and young adults. Retention in care and viral suppression are often used to measure outcomes and can be described in a stepwise manner, the care cascade. There may be a complex relationship between retention parameters and viral suppression. This study explored the risk factors for viral suppression based on retention status and characterized patterns and changes in retention status over time in youth and young adults. Methods: This study is a secondary analysis of data collected from a cohort of 137 youth and young adults age 18-30 years living with HIV who entered care between 2012-2014 at a large HIV clinic within an urban academic medical center in Baltimore, Maryland. Based on the outcome measures of viral suppression and retention in care over a two-year period, each individual was classified as Retained/Suppressed, Retained/Not Suppressed, Not Retained/Suppressed, Not Retained/Not Suppressed. Viral suppression was defined as HIV-1 RNA viral load of less than 200 copies/mL. We performed logistic regression to identify independent risk factors for not being virally suppressed in each of the retention groups. Retention status was also calculated after each year and the changes in status were assessed. Results: Of the 118 individuals included in the analysis, 41 individuals were retained in care and 77 did not meet the retention measure. Among those retained in care, female gender was independently associated with not being virally suppressed (AOR, 13.3 [95% CI, 1.56114.15]. In the group not retained in care, females (AOR=4.49, 95% CI, 1.14-17.86), individuals with CD4 count 200-349 cells/mm3 at entry (AOR=7.6, 95% CI, 1.30-45.41) and viral load at entry of 200 copies/mL (AOR=5.5, 95% CI, 1.13-26.47) had higher odds of not being virally suppressed. Overall, 35% (41/118) of individuals switched from retained to not retained after the first year and 6.7% (8/118) of individuals were not retained in the first year, but were in the second year. Conclusions: The relationship between retention in care and viral suppression is not linear and characteristics of those who are virally suppressed are different based on retention status. Understanding the characteristics of individuals with different patterns of engagement and suppression may help future programs in the design, implementation, and assessment of youth-targeted programs.