Outreach, mental health, and case management services: can they help to retain HIV-positive and at-risk youth and young adults in care?

To assess the impact of outreach, mental health, and case management services on retention in primary care of HIV+ and at-risk youth and young adult clients of the Boston HAPPENS program, a comprehensive adolescent HIV prevention and care network of agencies. Providers at 8 urban sites used standard data forms at each visit to collect background and service receipt information on at-risk clients aged 12-24 years. Data were aggregated across all visits for each client to create summary variables for the number of times each client received each type of service. The retention measure was the number of days between a client's first and last visits during the 4-year data collection period. Kaplan-Meier survival curve and Cox proportional hazards regression analyses were used to assess the association between receipt of the support services of interest and the retention measure. The median retention times were 21 days for male clients (range, 0-1406, N = 512), and 26 days for female clients (range, 0-1577, N = 914). Among males, 45% were retained beyond a month, 24% beyond a year, and 10% beyond 2 years. Similar proportions of females were retained beyond a month and a year, but more females were retained beyond 2 years (15%). After adjusting for other covariates, both male and female clients had significantly longer retention times if they received > or = 2 outreach contacts, or case management at > or = 3 visits. Among males, receipt of mental health counseling at > or = 2 visits also increased retention times. These findings suggest that provision of outreach, mental health, and case management services can improve retention in care of at-risk youth and young adults.