Objectives Despite being at a heightened risk of HIV, the use of pre-exposure prophylaxis (PrEP) among adolescents remains low, which may stem from access to this biomedical intervention and the comfort of providers caring for this priority population. Prior studies evaluating the comfort and knowledge of providers related to PrEP have focused on adult providers or been conducted prior to FDA approval of PrEP for adolescents. This study focuses on pediatric providers' knowledge and comfort regarding counseling and prescribing PrEP to adolescents. Materials and methods Two anonymous surveys were administered to self-identified clinical providers treating pediatric patients at least part-time and practicing in Maryland in 2016 (n=118) and 2020 (n=60). General awareness, prior training, and personal clinical practice regarding PrEP were compared between respondent groups, as well as respondent self-reported comfort related to specific clinical scenarios to determine if pediatric provider knowledge and comfort have changed over time. Results General awareness of PrEP rose between the two surveys, with respondents reporting traditional education sources (continuing education, training, or colleagues) and non-traditional sources (television, the Internet, or social media). There was no change in self-reported comfort related to counseling and prescribing PrEP between the two surveys, and overall clinical knowledge remained low, with many respondents unable to identify necessary laboratory tests needed to begin medication safely. Conclusions Despite an increase in general awareness, provider comfort with PrEP did not increase over time. There is a need for ongoing education for pediatric providers to increase comfort and knowledge of biomedical HIV prevention to make it more readily available.

AIMS:Adults with special health care needs (ASHCN) face significant disparities in access to oral health care and subsequent health outcomes, resulting from several etiologies. This study investigated perspectives of patients, caregivers, and providers to better understand care barriers and facilitators for ASHCN.METHODS:We conducted 26 semi-structured interviews with a purposive sample from an academic clinic specializing in oral health care for ASHCN with disabilities [patients (N = 4), caregivers (N = 8), and providers (N = 14)], and thematically analyzed transcripts for care barriers and facilitators.RESULTS:Three overarching themes that encompassed overlapping barriers and facilitators of oral health care for ASHCN emerged: relational aspects, provider training/experience, and infrastructure aspects. Themes include intersecting perceptions of factors that hinder or help oral health care and management of ASHCN.CONCLUSIONS:Building relationships with patients, inherent empathetic provider characteristics, and accommodating clinical infrastructure are imperative to facilitate oral health care for ASHCN. The primary themes revealed in this study are facilitators to care when they are present, and barriers to care when they are absent. No individual theme stands alone as a single contributor to quality care, and the provision of care for ASHCN relies on coordination of providers, patients, caregivers, and the overarching infrastructure.

Background MSM are disproportionately affected by HIV, a joint strategy of behavioral interventions and chemoprophylaxis, e.g. HIV post-exposure prophylaxis (PEP), is promising to reduce HIV infection. Worldwide PEP is recommended, and it has been prescribed to MSM over the past decade in many countries since 1990s. In order to better understand the role PEP played in HIV prevention among MSM, we reviewed literature to describe the global utilization of PEP. Methods We searched the following databases for publications in English through 19 May 2018: Pubmed, Scoups, Embase, the Cochrane Library and Web of Science. Eligible articles reported the following data on nPEP among MSM: reasons for and/or the uptake of nPEP, adherence to treatment guidelines, and HIV seroconversion among MSM prescribed PEP. Results Fifty-six studies were included Medical records showed nPEP prescriptions increased significantly among MSM, who accounted for the majority of nPEP users in most settings, ranging from 57% to 88.1%. Twenty-eight studies reported on the uptake of PEP among MSM, with an overall pooled proportion of 8.1% (95% CI 5.6% to 10.5%). One-fifth of MSM nPEP users obtained repeated prescription. With regard to reasons for nPEP use, unprotected receptive anal intercourse was more frequent than unprotected insertive anal intercourse (35–65.8% vs 20–28.8%). The pooled full completion (28-day course) was 91.6% (95%CI: 89.9–93.2%), with 100% adherence to the regimen ranging from 52% to 85%. Ten studies reported 498 HIV seroconversions among 18908 MSM, which resulted in a post use HIV incidence of 0.97 to 7.2 per 100 person-years. but there is no clear linkage between nPEP use and HIV seroconversions. Conclusion Our review demonstrated that PEP is underutilized as a HIV prevention strategy. Efforts are needed to raise awareness and knowledge of nPEP and engage MSM in this chemoprophylaxis. Efforts are also needed to reinforce completion and adherence among nPEP users. Disclosure No significant relationships.

ABSTRACT Adolescents and young adults (AYA) 13–24 years old make up a disproportionate 21% of new HIV diagnoses. Unfortunately, they are less likely to treat HIV effectively, with only 30% achieving viral suppression, limiting efforts to interrupt HIV transmission. Previous work with mindfulness-based stress reduction (MBSR) has shown promise for improving treatment in AYA living with HIV (AYALH). This randomized controlled trial compared MBSR with general health education (HT). Seventy-four 13–24-year-old AYALH conducted baseline data collection and were randomized to nine sessions of MBSR or HT. Data were collected at baseline, post-program (3 months), 6 and 12 months on mindfulness and HIV management [medication adherence (MA), HIV viral load (HIV VL), and CD4]. Longitudinal analyses were conducted. The MBSR arm reported higher mindfulness at baseline. Participants were average 20.5 years old, 92% non-Hispanic Black, 51% male, 46% female, and 3% transgender. Post-program, MBSR participants had greater increases than HT in MA (p = 0.001) and decreased HIV VL (p = 0.052). MBSR participants showed decreased mindfulness at follow-up. Given the significant challenges related to HIV treatment in AYALH, these findings suggest that MBSR may play a role in improving HIV MA and decreasing HIV VL. Additional research is merited to investigate MBSR further for this important population.

Strategies are needed to optimize HIV health care transition (HCT). We describe HCT outcomes within the University of Maryland STEP Program, which is built upon integration of an adult HIV provider and navigator into the pediatric clinic, and coordinated collaboration between pediatric and adult HIV multi-disciplinary care teams. These outcomes were compared to a historical institutional HCT cohort (N = 50) which attempted transition in an earlier time period (2004-2012). Fifty-eight patients were enrolled during the study period, and 34 attempted HCT. In total, 84 patients underwent attempted HCT. In the STEP cohort, linkage to adult care was 94% and 12 month retention in adult care (95%) was statistically higher compared to the historical cohort. Rates of viral suppression did not differ pre- and post-HCT among STEP Program patients. These results support the concept of an integrated pediatric and adult HIV HCT model though the ability to achieve sustainable HCT success will require further study.

Background Pre-exposure prophylaxis (PrEP) is a potential tool for reducing racial HIV disparities by reducing HIV acquisition among those at greatest risk. A recent bacterial STI is an important biomarker of HIV acquisition risk and represents one target for prioritizing PrEP in populations with the greatest HIV burden. Receipt of a PrEP prescription is an important step of the PrEP cascade. This study assessed whether race and recent STI diagnoses were associated with receipt of a PrEP prescription among men who have sex with men (MSM) in a PrEP program. Methods Race (non-Hispanic black, non-Hispanic white, other), recent STI diagnosis (self-reported diagnosis in past 3 months) and data on receipt of a PrEP prescription among MSM who met clinical eligibility criteria for PrEP were collected from September 2015 through March 2018. Participants were enrolled at one of six clinical sites participating in IMPACT, a multi-site PrEP demonstration project. Multivariable logistic regression analysis was used to determine the associations between race and recent STI diagnosis with receipt of a PrEP prescription. Results IMPACT screened 308 MSM as clinically eligible for PrEP and 287(93.2%) received a PrEP prescription; 153(49.7%) were non-Hispanic black and 109(35.4%) reported an STI diagnosis. MSM with black race (compared to white) (AOR=0.170; 95% CI=0.047–0.607) were significantly less likely to receive a PrEP prescription. MSM with a recent STI diagnosis (AOR=4.874; 95% CI=1.377–17.249) were more likely to receive a PrEP prescription. Conclusion MSM with recent STI diagnosis were more likely to receive PrEP prescriptions. The finding that black MSM are less likely to receive prescriptions suggest a barrier to PrEP delivery that may widen rather than reduce HIV disparities. Identifying and understanding these barriers to PrEP delivery are an important target for future research. Disclosure No significant relationships.

Abstract Background: Innovative strategies and protocols are required for effective provision of healthcare services and attainment of optimal positive health outcomes for adolescents living with HIV (ALHIV) as they transition to adult care.HIV-infected youth must learn to navigate a complex healthcare system as they transition from pediatric to adult care. Poorly planned transitions can result in non-adherence to ART, loss-to-follow-up in care and supportive services, with resultant negative health impact. This study evaluates two different approaches to the process of transition from pediatric to adult care in six facilities in Nigeria. Methods: ADAPT will use a cluster randomized intervention trial to measure the impact of Peer Transition Advocates (PTAs) versus Education Interventionists (EIs) approach to the process of transition of ALHIV, with imbedded psychosocial/social network analyses. The study will be conducted in 6 healthcare facilities (three tertiary and three secondary) in Northern and Central Nigeria. The unit of randomization (cluster) will be the facilities (n=180 per intervention arm, N=360), study participants 17-19 year-old ALHIV enrolled in the pediatric ART clinic for ≥12 months and know their HIV status. Sixty participants will be recruited pre-transition per site and followed up 12 months post-transition. Primary outcome measure will be proportion of ALHIV achieving successful transition and viral suppression 12 months post-transition comparing the two arms. Secondary outcome measures are proportion of ALHIV achieving ownership of care, improved quality of life, better transfer experience, and social support system measured by individual and ego-network evaluation tools correlating with successful transition. Discussion: ADAPT hypothesizes that by involving ALHIV in the study design, the PTA intervention will result in more successful transition and clinical outcomes in adult care. Further, we postulate that properly trained and supervised task-oriented peer support using lay workers assigned to track and guide each adolescent along the transition pathway in the clinic and in the community is the key starting point for transforming a dysfunctional system. Findings from ADAPT will guide institutions on best practices for transitioning ALHIV and other adolescents with chronic conditions in Nigeria and other resource-limited settings.

Background Bacterial STIs such as syphilis, rectal gonorrhea (GC) and chlamydia (CT) are strongly associated with increased risk of HIV acquisition, and are a marker of ongoing sexual risk behavior among HIV pre-exposure prophylaxis (PrEP) users. STI positivity among men who have sex with men (MSM) PrEP-users in settings where PrEP has been implemented is understudied. Our objective was to determine syphilis and rectal GC/CT positivity among MSM PrEP-users enrolled in a large PrEP demonstration project in Baltimore City, Maryland. Methods The demonstration project was a collaboration between a city health department, an academic evaluation partner, six clinical sites and one CBO. STI results at PrEP initiation and routine 6- and 12-month PrEP-care visits were collected among MSM receiving PrEP at participating clinical sites between September 30, 2015-March 31, 2018. Syphilis and rectal GC/CT positivity was calculated among those screened at each visit. Results During the study period, 290 MSM initiated PrEP, of whom 46.9%(136) were Black/African-American, and 51.4%(149) aged 25–34 years. At PrEP initiation, 79.2%(230) and 56.1%(165) were screened for syphilis and rectal GC/CT, respectively; the proportion screened at 6- and 12-month PrEP-care visits was slightly lower. Overall, including PrEP initiation and care visits, 11.6%(30/258) were ever syphilis positive, 17.9%(35/196) ever rectal GC positive, and 22.5%(44/196) ever rectal CT positive. Specifically, at PrEP initiation, 7.8%(18/230) were syphilis positive; 11.1%(18/162) rectal GC positive, and 11.7% (19/162) rectal CT positive. Positivity at 6- and 12-month PrEP-care visits was similar to positivity at PrEP initiation. Conclusion Despite CDC recommendations for biannual STI screening among PrEP-users, the proportion of MSM PrEP-users screened was suboptimal. The overall and ongoing positivity of syphilis and rectal GC/CT suggest that a substantial proportion of MSM PrEP-users may be engaging in ongoing sexual risk behaviors. Strategies are needed to encourage providers to screen PrEP-users more frequently for STIs and promote safer sexual practices. Disclosure No significant relationships.

Background Persistent HIV pre-exposure prophylaxis (PrEP) use is critical to preventing HIV acquisition. U.S. Centers for Disease Control and Prevention (CDC) recommends quarterly clinical evaluation for individuals using PrEP. Individual-level adherence to quarterly PrEP-care visits is largely unknown. Our objective was to describe patterns of quarterly PrEP-care visit attendance among individuals enrolled in a large demonstration project to increase PrEP delivery in Baltimore City, Maryland. Methods The project was a collaboration between a city health department, an academic evaluation partner, 6 clinical sites and one community based organization (CBO). Demographic and quarterly PrEP-care visit information from individuals initiating PrEP between October 1, 2015 and August 31, 2017 was abstracted from medical records using standardized forms. Participants were followed for one year. PrEP-care was categorized as ‘Persistent’ (attending all quarterly PrEP-care visits), ‘Episodic’ (missing > 1 PrEP-care visit and re-engaging PrEP-care visit), or ‘Discontinued’ (lost to follow-up after missing > 1 PrEP-care visit). Results During the study period, 333 individuals initiated PrEP, among whom 52.9% (176) were Black/African-American, 82.3% (274) cisgender male, 73.6% (245) men who have sex with men (MSM), and 47.7% (159) aged 25–24 years. 9.0% (30), 40.5% (135), and 50.5% (168) were persistent, episodic and discontinued PrEP-care users, respectively. Over half (51.1%, 69/135) of episodic users missed the first quarterly visit; mean time to PrEP re-engaging was 6.3 months (SD: 2.18). About half (45.2%, 76/168) of those discontinuing PrEP-care did so within 3-months. Conclusion Over one year, < 10% of individuals initiating PrEP were persistently in PrEP-care, and half discontinued PrEP-care completely. This suggests PrEP’s effectiveness in reducing HIV transmission in Baltimore City may be limited. Future work should focus on identifying individual and structural barriers and facilitators to discontinuing PrEP-care and factors associated with re-engaging PrEP-care to inform interventions to improve persistent PrEP-care, and decrease ongoing HIV transmission. Disclosure No significant relationships.

Objective: Conflicting data exist regarding the impact of in-utero exposure to maternal combination antiretrovirals. We compared neurodevelopmental outcomes between HIV-exposed-uninfected (HEU) children exposed in utero to three-drug combination antiretroviral therapy (ART) vs. zidovudine (ZDV) monotherapy. Design: Prospective study of child neurodevelopment, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional). Methods: The Tshipidi and Mma Bana studies enrolled HIV-infected women during pregnancy and followed their HEU children for 24 months. Mothers took three-drug ART or ZDV during pregnancy. ART-exposed babies were mostly breastfed, and ZDV-exposed were formula-fed. Neurodevelopmental outcomes, measured at 24 months using Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) and Development Milestones Checklist (DMC), were compared in adjusted linear regression according to antiretroviral exposure. Results: Of 598 HEU children with valid neurodevelopment assessments, 382 were ART-exposed and 210 were ZDV-exposed. Adjusted mean Bayley-III scores were similar among ART-exposed vs. ZDV-exposed, with adjusted mean differences (95% confidence interval): Bayley-III Cognitive: −0.3 (−1.4, 0.9); Gross Motor: 0.8 (−0.1, 1.7); Fine Motor: 0.5 (−0.2, 1.3); Expressive Language: 0.7 (−0.3, 1.7); Receptive Language: 0.1 (−0.7, 0.8); and DMC Locomotor: 0.0 (−0.5, 0.6); Fine Motor: 0.3 (−0.3, 0.8); Language: −0.1 (−0.5, 0.4); Personal-Social: 0.2 (−0.7, 1.1). Similarly, when restricted to formula-fed children in one cohort (Tshipidi), there were no differences in adjusted mean scores. Conclusion: Neurodevelopmental outcomes at 24 months of age were similar in ART-exposed vs. ZDV-exposed HEU children. Maternal ART with breastfeeding does not appear to have an adverse effect on neurodevelopment.

Background: In utero exposure to nucleoside reverse transcriptase inhibitor (NRTI)-containing antiretroviral treatment (ART) regimens may be associated with poor neurodevelopmental functioning in children of HIV-infected mothers. We investigated neurodevelopmental outcomes of HIV-exposed uninfected (HEU) children of HIV-infected women enrolled in a randomized trial of abacavir/zidovudine/lamivudine (triple-NRTI regimen) vs. lopinavir/ritonavir/zidovudine/lamivudine [dual-NRTI + protease inhibitor (PI) regimen]. Setting: The Mma Bana randomized trial was conducted in urban and rural sites in Botswana. Methods: The Mma Bana study randomized HIV-infected pregnant women with CD4 ≥200 cells per mm3 to a triple-NRTI vs. dual-NRTI + PI regimen from 26- to 34-week gestation through planned weaning at 6-month postpartum. Partway through the study, neurodevelopmental assessments were added at 24 months of age, including the Developmental Milestones Checklist, the Bayley Scales of Infant and Toddler Development third edition, Ten Questions Questionnaire, and Profile of Social Emotional Development. We evaluated differences in mean scores between the 2 arms using unadjusted and adjusted linear regression. Results: A total of 197 HEU infants (48% male) completed a neurodevelopmental assessment (101 in triple-NRTI arm and 96 in dual-NRTI + PI-exposed arm). Mean values for all neurodevelopmental outcomes were similar for children of mothers randomized to either ART regimen, with no significant differences in either unadjusted or adjusted models (estimated effect sizes ranging from −0.12 to 0.14). Conclusions: Neurodevelopmental outcomes in 24-month-old HEU children of HIV-infected mothers with baseline CD4 ≥200 were similar in those randomized to a dual-NRTI + PI–based vs. a triple-NRTI–based ART regimen, suggestive of lack of short-term toxicity. Monitoring of long-term toxicity and newer regimens is warranted.

Adolescents and young adults living with HIV (YLHIV) face numerous stresses that affect their care and medication adherence. The clinic social environment may play an important supportive role for YLHIV, influencing health outcomes. The aim of this article is to explore how YLHIV in Baltimore, Maryland understand the various forms of social support provided within the social environment of their HIV clinic. We used qualitative research methods including iterative, semi-structured in-depth interviews with 20 YLHIV interviewed up to three times each to explore HIV stressors, support systems, and medication adherence. We employed thematic content analysis to systematically code and synthesize textual interview data. We found that YLHIV experienced social embeddedness with their healthcare teams and through clinic activities. Participants largely perceived these social connections as support, acknowledging that these supports are available to them when needed. Support was enacted through the provision of instrumental support for issues outside of the young person's medical care (i.e., finding a crib for a participant's baby), appraisal (i.e., through respect of the young person's agency and decision making), and information about their HIV care and medication. Support was not always well received, however, as some young people found the support from clinicians demeaning. Limitations of the clinic social support environment included concerns about trust and privacy, and perceiving support as inappropriate or unwanted. Participants identified a number of ways in which the clinic provided meaningful social support. Future research should explore how these supports may improve care and medication adherence of YLHIV.

Introduction: The transition from paediatric to adult care poses risks to the health of young adults living with HIV if unsuccessful, including interruptions in care and poor health outcomes. Evolving best practices in HIV healthcare transition should ideally be informed by real-world qualitative and quantitative clinical healthcare transition outcomes. There has been a recent proliferation of HIV healthcare transition outcome research, largely from Europe and North America.Methods: A literature search was undertaken using the online databases PubMed, Web of Science, and Google Scholar. Medical subject and text word searches were combined for terms relating to HIV, paediatric transition outcomes, and internal and external factors were used to identify peer-reviewed articles.Results: In this paper, we review data on HIV healthcare transition outcomes in North America and Europe. Internal and external factors which may impact the success of HIV healthcare transition are examined. We describe ongoing research efforts to capture transition outcomes in the North America and Europe. Clinical, operational, and implementation science research gaps that exist to date are highlighted. Efforts to improve HIV healthcare transition research through country-level surveillance networks and large multicentre cohorts, including data integration and linkage between paediatric and adult cohorts are discussed.Conclusions: We identified the need for a comprehensive approach to implementing empirically supported protocols to support healthcare transition for ALHIV. While there is limited prospective longitudinal cohort data available at this time, cohorts linking the paediatric and adolescent with ongoing surveillance into adulthood are being developed. Through a review of existing qualitative and quantitative healthcare transition outcomes studies, we identify emerging areas of consensus surrounding healthcare transition research implementation. Successful healthcare transition programmes in Europe and North America often share several characteristics, including implementation of a youth friendly multidisciplinary approach, consistent communication and integration between paediatric and adult care teams, and an individualized approach which is attuned the adolescent's transition readiness. Moving forward, the voices of youth and young adults living with HIV should be included in the development and evaluation of healthcare transition protocols to ensure that the definition of successful transition reflects all of the stakeholders in the transition process.

BACKGROUND:We sought to determine if HIV-exposed uninfected (HEU) children had worse neurodevelopmental outcomes at 24 months compared with HIV-unexposed uninfected (HUU) children in Botswana.METHODS:HIV-infected and uninfected mothers enrolled in a prospective observational study ("Tshipidi") in Botswana from May 2010 to July 2012. Child neurodevelopment was assessed at 24 months with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III: cognitive, gross motor, fine motor, expressive language, and receptive language domains) and the Development Milestones Checklist (DMC), a caregiver-completed questionnaire (locomotor, fine motor, language and personal-social domains). We used linear regression models to estimate the association of in-utero HIV exposure with neurodevelopment, adjusting for socioeconomic and maternal health characteristics.RESULTS:We evaluated 670 children (313 HEU, 357 HUU) with ≥1 valid Bayley-III domain assessed and 723 children (337 HEU, 386 HUU) with a DMC. Among the 337 HEU children with either assessment, 122 (36%) were exposed in utero to maternal 3-drug antiretroviral treatment and 214 (64%) to zidovudine. Almost all HUU children (99.5%) breastfed, compared with only 9% of HEU children. No domain score was significantly lower among HEU children in adjusted analyses. Bayley-III cognitive and DMC personal-social domain scores were significantly higher in HEU children than in HUU children, but differences were small.CONCLUSIONS:HEU children performed equally well on neurodevelopmental assessments at 24 months of age compared with HUU children. Given the global expansion of the HEU population, results suggesting no adverse impact of in-utero HIV and antiretroviral exposure on early neurodevelopment are reassuring.

ABSTRACT Outcomes following healthcare transition (HCT) from pediatric to adult HIV care are not well described. We sought to describe clinical outcomes following HCT within our institution among young adults with behavioral-acquired (N = 31) and perinatally-acquired (N = 19) HIV. We conducted a retrospective cohort study among HIV-infected adults who attempted transition from pediatric to adult HIV care within our institution. The primary end point was retention in care, defined as the completion of at least two visits over 12 months following linkage to adult care. Additional end points include time to linkage to adult care, and changes in CD4 + T cell count and HIV RNA across time. Outcomes were compared between perinatal and behavioral HIV cohorts. Binary data were analyzed using the Fisher exact test and continuous data were analyzed using the Mann–Whitney test. Forty-three (86%) of 50 patients were successfully linked to adult care. The median time to linkage was 98 days. Fifty percent of patients achieved full retention in care at 12 months post-linkage. Though those with behavioral-acquired HIV attempted transfer at an older age, the groups did not differ in rates of linkage and retention in adult care. CD4 + T cell counts and rates of viral suppression did not differ between pre- and post-HCT periods. Despite high rates of successful linkage to adult care in our study population, rates of retention in adult HIV care following HCT were low. These results imply that challenges remain in the adult HIV care setting toward improving the HCT process.

HIV is a chronic illness for those accessing treatment. Internationally, the palliative approach has reduced HIV symptom burden and improved outcomes in resource-constrained settings. Data presented here are from a study evaluating a curriculum to introduce the palliative approach early (ePA) in patient treatment to improve outcomes for those difficult to engage and retain in care---specifically, young men who have sex with men (yMSM). Using a quasi-experimental design, serial surveys are collected from yMSM (18 – 35 years) at two outpatient HIV clinics in one US city with high rates of poverty, violence, and substance abuse. Sociodemographics, psychosocial support, life events, substance use and mental health information are collected. Of 171 patients accrued, 77% are African American; 44% employed, 17% disabled; and 27% previously incarcerated. Viral measurement was suppressed (LT 200 copies/cc3) for 62%, although 60% missed a third, or more, of clinic visits in the past 6 months. Recent marijuana use is reported by 57%, 34% have an alcohol problem, and 11% used cocaine recently. High levels of depressive symptomatology are reported, with 44% scoring above the clinical case definition cutoff. On average, these young patients, or someone they knew, experienced nearly 4 of 17 serious adverse events, 44% experienced 3 or more such events. Depressive symptomatology was significantly correlated with the number of life events encountered (r=.302; p< .001) and personally experienced (r=.298; < .001). Those who experienced 3 or more events were twice as likely as those reporting none to have an alcohol problem (48% vs. 24%; 2=10.769, df=1, =.062). A majority of HIV+ yMSM have achieved viral suppression, despite psychosocial vulnerabilities placing them at increased risk for poor physical and psychological outcomes. Given their historical and concurrent needs, maintenance of viral suppression is likely predicated upon clinical services incorporating holistic management. Use of the palliative approach early in HIV disease management may assist staff in focusing their efforts to retain difficult to reach patients.

Patients with perinatally acquired HIV may be at risk for the development of age-related non-AIDS diseases. The primary aim of this study was to describe patterns of systemic hypertension among a cohort of adults (≥18 years) with perinatally acquired HIV. A retrospective cohort study was conducted among adults (≥18 years) with perinatally acquired HIV infection. Primary outcomes included documentation of systemic hypertension as well as several additional non-AIDS-associated illnesses. Systemic hypertension incidence rates and rate ratios (RRs) were calculated among groups aged ≥18 and <18 years at the time of hypertension diagnosis. The overall prevalence of hypertension in the cohort (N = 109) was 26.6%, and the incidence rate of hypertension was significantly higher among those aged ≥18 years compared to those who are aged <18 years at the time of diagnosis (RR: 10.0, CI: 7.29-13.71). By multivariable analysis, only coexisting renal disease was associated with an increased risk of hypertension diagnosis.

Human immunodeficiency virus (HIV), a chronic illness for those accessing treatment, requires a paradigm shift moving from viral measurements alone to a perspective that encompasses quality of life as defined by the index person and his support system. HIV positive young men who have sex with men are at high risk for poor outcomes and for spreading disease, in part, because they are difficult to engage and retain in care. Outpatient staff themselves may be a contributing factor. We employed the palliative approach early (ePA) to assist non-palliative outpatient staff in improving outcomes for a difficult to engage and retain HIV population. Grounded in multidisciplinary, US-based didactic and iterative educational methods, we trained a multidisciplinary coaching team in elements of the palliative approach previously observed applicable to outpatient HIV disease management in international resource-constrained settings. On-site case discussion and coaching, with quarterly in-service educational sessions for all staff, then followed. An independent stakeholder advisory panel gave input at each step of the curriculum refinement. The curriculum was introduced in one US HIV clinic where a second HIV clinic served as the control. The ePA attends to patients’ holistic needs at critical life-course transitions. We introduced 8 PA skills: need for staff self-care when learning new skills; basic team building; respect for the individual; P2/S2 assessment (physical; psycho-emotional; social; spiritual); communication skills about difficult to discuss topics; calendar driven goal-setting rather than crisis driven; symptom recognition and management; and reflection. Accepted behavior change techniques were employed and challenges observed. External factors, such as a syndemic environment, may impact the ability of both patients and staff to form relationships. Point-of-service self-care strategies are critical when introducing new skills. The palliative approach used early may assist HIV staff in understanding the impact of care delivery upon specific patients and facilitate patients’ engagement and retention in care.