Browsing by Author "Monte, Dina"

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    HIV Continuum of Care for Youth in the United States
    (Wolters Kluwer, 2018-01-01) Lally, Michelle A.; van den Berg, Jacob J.; Westfall, Andrew O.; Rudy, Bret J.; Hosek, Sybil G.; Fortenberry, J. Dennis; Monte, Dina; Tanney, Mary R.; McFarland, Elizabeth J.; Xu, Jiahong; Kapogiannis, Bill G.; Wilson, Craig M.; Pediatrics, School of Medicine
    BACKGROUND: Beneficial HIV treatment outcomes require success at multiple steps along the HIV Continuum of Care. Youth living with HIV are a key population, and sites in the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) are known for modeling optimum HIV adolescent care. METHODS: A longitudinal cohort study conducted at 14 network sites across the United States assessed how the later steps of the Continuum of Care were achieved among the youth: engagement, treatment, and viral load (VL) suppression. Youth aged 13-24 who were behaviorally infected with HIV and linked to care at an ATN-affiliated site were eligible to participate. RESULTS: A total of 467 youth were enrolled and had 1 year of available data. Most were aged 22-24 (57%), male (79%), and black/non-Hispanic (71%). Most used alcohol (81%) and marijuana (61%) in the 3 months before enrollment, and 40% had a history of incarceration. Among this cohort of youth, 86% met criteria for care engagement; among these, 98% were prescribed antiretroviral therapy and 89% achieved VL suppression. Sustained VL suppression at all measured time points was found among 59% with initial suppression. Site characteristics were notable for the prevalence of adherence counseling (100%), case management (100%), clinic-based mental health (93%), and substance use (64%) treatment. CONCLUSIONS: Youth living with HIV in the United States can be successfully treated at health care sites with experience, excellence, and important resources and services. Sustained VL suppression may be an important step to add to the Continuum of Care for youth.
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    HIV viral load levels and CD4+ cell counts of youth in 14 cities
    (Wolters Kluwer, 2014) Ellen, Jonathan M.; Kapogiannis, Bill; Fortenberry, J. Dennis; Xu, Jiahong; Willard, Nancy; Duval, Anna; Pace, Jill; Loeb, Jackie; Monte, Dina; Bethel, James; Adolescent Medicine Trials Network for HIV/AIDS Interventions; Pediatrics, School of Medicine
    Objectives: To describe the HIV viral load and CD4 cell counts of youth (12-24 years) in 14 cities from March 2010 through November 2011. Methods: Baseline HIV viral load and CD4 cell count data were electronically abstracted in a central location and in an anonymous manner through a random computer-generated coding system without any ability to link codes to individual cases. Results: Among 1409 HIV reported cases, 852 participants had data on both viral load and CD4 cell counts. Of these youth, 34% had CD4 cell counts of 350 or less, 27% had cell counts from 351 to 500, and 39% had CD4 cell counts greater than 500. Youth whose transmission risk was male-to-male sexual contact had higher viral loads compared with youth whose transmission risk was perinatal or heterosexual contact. Greater than 30% of those who reported male-to-male sexual contact had viral loads greater than 50 000 copies, whereas less than 20% of heterosexual contact youth had viral loads greater than 50 000 copies. There were no differences noted in viral load by type of testing site. Conclusion: Most HIV-infected youth have CD4 cell counts and viral load levels associated with high rates of sexual transmission. Untreated, these youth may directly contribute to high rates of ongoing transmission. It is essential that any public health test and treat strategy place a strong emphasis on youth, particularly young MSM.
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    Linkage to care for HIV-positive adolescents: A multi-site study of the Adolescent Medicine Trials Units of the Adolescent Trials Network
    (Elsevier, 2012) Fortenberry, J. Dennis; Martinez, Jaime; Rudy, Bret J.; Monte, Dina; Pediatrics, School of Medicine
    Purpose: To understand linkage to care practices at sites providing clinical services to newly diagnosed HIV-positive adolescents. Methods: Qualitative analysis of detailed interviews conducted with 28 personnel involved in linkage to care at 15 sites providing specialty care to HIV-positive adolescents. Results: We showed that multiple models exist for linkage to care, and that both formal and informal community relationships are important for successful linkage to care. Stigma was seen as a universal issue, enhancing the importance of the balance of confidentiality and social support. Barriers to care, such as mental health issues, substance use, and transportation, are common. Conclusions: We conclude that the complexity of linkage to care requires thought and planning as HIV testing is expanded to lower-risk populations.