906 
Characteristics Associated with Retention for Hard-to-Reach Young Men of Color Who Have Sex with Men
Manya Magnus*1, K Jones1, G Phillips II1, D Binson2, L Hightow-Weidman3, C Richards-Clarke4, A Wohl5, A Outlaw6, T Giordano7, B Nyanthi8, and the Young MSM of Color SPNS Initiative Study Group
1George Washington Univ Sch of Publ Hlth and Hlth Svcs, Washington, DC, US; 2Ctr for AIDS Prevention Svcs, Univ of California, San Francisco, US; 3Univ of North Carolina at Chapel Hill, US; 4Bronx AIDS Svcs Inc and Children`s Hosp at Montefiore Med Ctr, NY, US; 5Los Angeles County Hlth Dept, CA, US; 6Horizons Project, Wayne State Univ, Detroit, MI, US; 7Baylor Coll of Med, Houston, TX, US; and 8AIDS Project East Bay, Oakland, CA, US
Background: Young men of color who have sex with men
(YMCSM) represent a subpopulation at risk of infection and lack of access to
HIV-related clinical care. In 2003, the US Health
Resources and Services Administration (HRSA) funded 8
demonstration sites and 1 evaluation center for a Special Projects of National
Significance (SPNS) to identify best practices for outreach, linkage, entry,
and retention in care for HIV+ YMCSM.
Methods: The purpose of this study is to
characterize factors associated with poor retention among this cohort of
hard-to-reach YMCSM newly entered into care. Data were collected quarterly by
face-to-face interview and chart abstraction for HIV+ YMCSM at the 8
sites. Uni-, bivariate, and GEE methods were used to describe characteristics
associated with missing a quarterly visit due to inability to contact the
participant following a missed study or clinic visit. Analyses were conducted
in Stata 9.0se.
Results: Of 224 participants, 72.7% were African
American, 28.3% Latino; 66.5% were 19 to 22 years old, 35.0% still in school,
and 36.8% living with parents. At baseline, 20.3% had HIV viral load of ≥100,000
and 12.2% had CD4 <200. Of 529 expected follow-up visits, 69 (13.0%) were
not completed with the majority due to not being able to reach client (75.4%)
or medical crisis/hospitalization (20.3%); 12.9% of participants ever missed a
visit due to non-contact. Prior to adjustment for confounders, disclosure of
HIV status to a parent was associated with being less likely to miss a visit due
to non-contact (OR 0.37, 95%CI 0.17 to 0.84) as was having parent’s medical
insurance (0.09, 0.02 to 0.54). After adjusting for insurance and school
status, CD4 count <200 and age ≥21 were associated with missing at
least one visit for non-contact (OR 5.34, 95%CI 1.10 to 25.98 and OR 7.14, 95%CI
1.05 to 50.00, respectively). Reporting a period of depression or suicidal
ideation was associated with being less likely to miss a visit (OR 0.15, 95%CI
0.03 to 0.80).
Conclusions: Among hard-to-reach YMCSM adolescents,
retention was a greater challenge for older individuals and those with lower
CD4 counts, suggesting differential adolescent needs across the span of
adolescence and disease staging. Previously reported barriers to adolescent
care, including depression, disclosure to parents, and parental insurance did
not appear to affect retention in this cohort. Youth- and patient-specific
retention strategies are necessary to develop novel approaches to providing
this high-risk population with continuity of HIV care.
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