Retention and viral suppression with differentiated time or space for adolescent and young adult HIV care: a systematic review and meta-analysis.

Abstract

Introduction: Adolescents and young adults living with HIV (AYAWH) encounter unique barriers affecting their adherence to treatment and overall health outcomes. Differentiated care for AYAWH has been suggested as a strategy to improve treatment outcomes for this demographic. This study evaluated the evidence on antiretroviral treatment outcomes of a differentiated care model with designated space or service time for AYAWH.

Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. A literature search was conducted using PubMed and Embase and included peer-reviewed articles published in English. Articles comparing retention and viral suppression rates at differentiated adolescent or young adult-specific services with those at local standards of care facilities were included in the analysis. Differentiated care encompassed separate spaces (such as dedicated rooms or buildings) or operating hours designated exclusively for AYAWH. A random-effects meta-analysis was conducted to generate pooled risk ratios (RR) to evaluate the effectiveness of these tailored care models.

Results: We identified 11 eligible articles, 10 of which from resource-limited settings in Africa. The meta-analysis revealed that differentiated time or space care for AYAWH significantly increases rates of retention (pooled RR 1.19, 95%CI 1.13-1.26) and viral suppression (pooled RR 1.11, 95%CI 1.05-1.17) among AYAWH, although moderate heterogeneity was observed in both outcomes (I2 of 69.5% and 57.3% for retention and viral suppression, respectively).

Conclusion: Implementation of differentiated time or space for adolescent and young adult HIV care significantly improves retention and viral suppression rates among AYAWH.