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Introduction: Youth with perinatally-acquired HIV (PHIV) are living well into young adulthood. There has been extensive research on the social impacts of PHTV on adolescents and young adults (AYA). However, little research has examined their broader family system. This qualitative exploratory project examined the perspectives of caregivers raising AYA with PHTV. Method: Eighteen caregivers who cared for adolescents and young adults with PHTV over the age of 14 completed semistructured audio-recorded interviews. Questions focused on salient aspects of adolescent development and parenting experiences over the course of their child's life. Transcripts were coded for emergent themes. Results: Past and present caregiving experiences were consistently contextualized by the stigmatized nature of HIV. Daily concerns related to medication adherence and sexual behavior were common. Future-oriented expectations were marked by hope, as well as an acknowledgment of continued struggle. Discussion: Negative experiences with the health care system underscore the need for ongoing education about HIV-related stigma. Findings suggest that caregivers, like other parents of typically developing youth, may need support addressing sexuality. Additionally, caregivers expressed concerns over the appropriate levels of supervision to offer their AYA as they assumed more responsibility for their own health. Collaboration among psychosocial and health care professionals to identify support strategies will benefit both caregivers and AYA living with PHTV. Keywords: adolescents and young adults, caregivers, perinatally-acquired HIV, Before antiretroviral treatment in the early 1990s, the likelihood of perinatal HIV transmission was 15% to 49% (Connor et al., 1994), During this time, many pregnant women were vilified because [...]

Context: Firearm injury is the leading cause of death for individuals aged 12-24. Despite far-reaching impacts of gun violence, there is insufficient data available to inform prevention strategies. Screening adolescent patients and counseling those at high risk is one promising strategy that family physicians could implement in their clinics to prevent firearm exposure. However, few validated clinical tools are available to help physicians understand their patients' risk. One new tool is the SaFETy questionnaire, a 4-item scoring system found to predict twenty-four month gun violence exposure in drug-using adolescents presenting to an urban emergency room. This tool has yet to be validated in a primary care setting. Objective: Validation of the SaFETy questionnaire as a predictor of gun violence in a nonurban primary care setting. Study Design and Analysis: Longitudinal quantitative study. Multivariate linear regression with gun violence exposure as the dependent variable and SaFETy score and other assessments/survey questions and demographics as independent variables. Setting: primary care practices in eastern North Carolina Population Studied: Patients (age 14-24) at four ## moderately-sized semi- urban and rural primary care clinics. Intervention/Instrument: Baseline and six months post-enrollment surveys assessing patient demographics; SaFETy questionnaire; gun violence exposure, peer influence, and parent behavior measures; and community violence exposures. Outcome Measures: SaFETy score and gun violence exposure Results: The majority of the patients were female (69%), non-Hispanic or Latinx (73%), and had at least a high school diploma or GED (63%). 45% were white and 36% were Black or African-American. The majority of respondents had easy access to a gun (61%). Correlations between baseline and six months post baseline show association between the SaFETy score and a variety of different gun violence exposures including from friends, parents or guardians, and during various situations. Conclusions: When used in a primary care setting, the SaFETy score is a useful tool in helping to predict the risk of gun violence exposure in an adolescent population. Learning Objectives: Understand the relevance of the SaFETy questions in predicting gun violence & Understand the importance for primary care clinicians to predict gun violence risk Research Category: Child and Adolescent Health Study Design: Longitudinal quantitative study conducted over six month, Presenters Sanjay Batish, MD, Anna Gilbert, BS, Cory Lutgen, BS, BSc, Elisabeth Callen, [...]

This study examines the efficacy of the Japanese version of the Program for the Education and Enrichment of Relational Skills (PEERS), which focuses on improving social functioning through making friends and maintaining good relationships for adolescents with autism spectrum disorder (ASD) without intellectual disabilities. Originally developed in the United States, PEERS is one of the few evidence-based social skills training programs for youth with ASD. The present study shows that with linguistic and cultural modifications, PEERS is effective in improving social functioning for adolescents with ASD in Japan. Positive results were found specifically in the areas of socialization, communication, knowledge of social skills, autistic mannerisms, and behavioral and emotional problems. In addition, most treatment gains were maintained at a 3-month follow-up assessment. These findings suggest that the Japanese version of PEERS is beneficial across multiple socio-emotional and behavioral domains for adolescents with ASD., Author(s): Tomoko Yamada [sup.1] [sup.2] , Yui Miura [sup.3] , Manabu Oi [sup.1] [sup.2] , Nozomi Akatsuka [sup.1] [sup.2] , Kazumi Tanaka [sup.4] , Naotake Tsukidate [sup.5] , Tomoka Yamamoto [...]

To conduct our scoping review of risk and protective factors for firearm violence among youth, we searched PubMed, Scopus, EMBASE, and Criminal Justice Abstracts for English-language research articles published between January 1985 and May 2018. We included studies of modifiable risk or protective factors associated with intentional (including suicide) or unintentional firearm victimization or perpetration with samples that included youth [less than or equal to] 17. Among the 28 included studies, 15 explored risk/protective factors for victimization, five focused on perpetration, five did not differentiate between victimization and perpetration, and five focused on suicide. Most studies examined individual-level risk factors. The few that explored factors beyond the individual were limited by methodological weaknesses and inconsistent findings. Protective factors for youth firearm outcomes were understudied. We need more research on youth firearm violence using longitudinal data and robust statistical methods. Future research is needed to understand the underlying mechanisms by which risk/protective factors influence firearm violence., Author(s): Carissa J. Schmidt [sup.1] , Laney Rupp [sup.1] , Jesenia M. Pizarro [sup.2] , Daniel B. Lee [sup.1] , Charles C. Branas [sup.3] , Marc A. Zimmerman [sup.1] Author [...]

Background Adolescence is a critical point in the realization of human capital, as health and educational decisions with long-term impacts are made. We examined the role of early childhood experiences on health, cognitive abilities, and educational outcomes of adolescents followed up from a longitudinal cohort study in Pakistan, hypothesizing that early childhood experiences reflecting poverty would manifest in reduced health and development in adolescence. Methods and findings Adolescents/young adults previously followed as children aged under 5 years were interviewed. Childhood data were available on diarrhea, pneumonia, and parental/household characteristics. New data were collected on health, anthropometry, education, employment, and languages spoken; nonverbal reasoning was assessed. A multivariable Bayesian network was constructed to explore structural relationships between variables. Of 1,868 children originally enrolled, 1,463 (78.3%) were interviewed as adolescents (range 16.0-29.3 years, mean age 22.6 years); 945 (65%) lived in Oshikhandass. While 1,031 (70.5%) of their mothers and 440 (30.1%) of their fathers had received no formal education, adolescents reported a mean of 11.1 years of education. Childhood diarrhea (calculated as episodes/child-year) had no association with nonverbal reasoning score (an arc was supported in just 4.6% of bootstrap samples), health measures (with BMI, 1% of bootstrap samples; systolic and diastolic blood pressure, 0.1% and 1.6% of bootstrap samples, respectively), education (0.7% of bootstrap samples), or employment (0% of bootstrap samples). Relationships were found between nonverbal reasoning and adolescent height (arc supported in 63% of bootstrap samples), age (84%), educational attainment (100%), and speaking English (100%); speaking English was linked to the childhood home environment, mediated through maternal education and primary language. Speaking English (n = 390, 26.7% of adolescents) was associated with education (100% of bootstrap samples), self-reported child health (82%), current location (85%) and variables describing childhood socioeconomic status. The main limitations of this study were the lack of parental data to characterize the home setting (including parental mental and physical health, and female empowerment) and reliance on self-reporting of health status. Conclusions In this population, investments in education, especially for females, are associated with an increase in human capital. Against the backdrop of substantial societal change, with the exception of a small and indirect association between childhood malnutrition and cognitive scores, educational opportunities and cultural language groups have stronger associations with aspects of human capital than childhood morbidity., Author(s): Zeba A. Rasmussen 1,*, Wasiat H. Shah 2, Chelsea L. Hansen 1, Syed Iqbal Azam 3, Ejaz Hussain 4, Barbara A. Schaefer 5, Nicole Zhong 5, Alexandra F. Jamison [...]

Introduction: Wraparound services (i.e., community-based collaborative care) for children with severe mental health needs have been reported as effective. Yet, no attention has been given to aggregating treatment results across racially and economically diverse groups of youth. While controlling for socioeconomic status (i.e., free/reduced lunch status) this study explored potential racial disparities in response to wraparound services. Method: Data from a diverse statewide sample (N = 1,006) of low-income youth (ages 6-18 years) identified as having a serious emotional disturbance were analyzed for differences in wraparound attrition, fidelity, and effectiveness. Results: African American youth receiving free/reduced lunch failed to complete wraparound services at significantly higher rates when compared to Caucasian youth. For those who met treatment goals (i.e., completed services), mean intervention fidelity scores showed services to be implemented similarly across youth. Furthermore, wraparound services resulted in improvements in mental health functioning, though racial background and attrition status impacted exit scores. Discussion: Collaborative community-based mental health services improve youth outcomes and physicians and school personnel should strive to be part of these teams. Further research is needed to more closely examine the challenges of helping youth to meet the goals associated with their wraparound services. Relatively higher service attrition rates in low-income African American youth warrants further investigation. Keywords: wraparound services, racial diversity, evidence-based interventions, attrition, fidelity, The majority of research conducted on addressing mental health concerns has been based on individuals of the dominant race and culture (i.e., Caucasian; Suter & Bruns, 2009). Therefore, investigating whether [...]

: Introduction: Respondent‐driven sampling (RDS) has been an effective sampling strategy for HIV research in many settings, but has had limited success among some youth in the United States. We evaluated a modified RDS approach for sampling Black and Latinx sexual and gender minority youth (BLSGMY) and explored how lived experiences and social contexts of BLSGMY youth may impact traditional RDS assumptions. Methods: RDS was implemented in three US cities, Baltimore, Philadelphia and Washington DC, to engage BLSGMY aged 15 to 24 years in HIV prevention or care intervention trials. RDS was modified to include targeted seed recruitment from venues, Internet and health clinics, and provided options for electronic or paper coupons. Qualitative interviews were conducted among a sub‐sample of RDS participants to explore their experiences with RDS. Interviews were coded using RDS assumptions as an analytic framework. Results: Between August 2017 and October 2019, 405 participants were enrolled, 1670 coupons were distributed, with 133 returned, yielding a 0.079 return rate. The maximum recruitment depth was four waves among seeds that propagated. Self‐reported median network size was 5 (IQR 2 to 10) and reduced to 3 (IQR 1 to 5) when asked how many peers were seen in the past 30 days. Qualitative interviews (n = 27) revealed that small social networks, peer trust and targeted referral of peers with certain characteristics challenged network, random recruitment, and reciprocity assumptions of RDS. HIV stigma and research hesitancy were barriers to participation and peer referral. Other situational factors, such as phone ownership and access to reliable transportation, reportedly created challenges for referred peers to participate in research. Conclusions: Small social networks and varying relationships with peers among BLSGMY challenge assumptions that underlie traditional RDS. Modified RDS approaches, including those that incorporate social media, may support recruitment for community‐based research but may challenge assumptions of reciprocal relationships. Research hesitancy and situational barriers are relevant and must be addressed across any sampling method and study design that includes BLSGMY in the United States., INTRODUCTION Respondent‐driven sampling (RDS) has gained popularity in HIV research over the last two decades as a means to sample populations for whom a sampling frame is unavailable [1,2]. This [...]

PU23.03 Being a part of the conversation: capacitating youth to participate in HIV prevention conversations using a digital citizen engagement platform in South Africa D. Pillay (1) ; K. Plourde [...]

: Introduction: We assessed mortality and losses to follow‐up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Methods: Cohorts in the Asia‐Pacific, the Caribbean, Central, and South America, and sub‐Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow‐up started at age 10 years or the first clinic visit, whichever was later. Entering care at Results: Of the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care Conclusions: Both mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population‐specific reasons for death and LTFU., Introduction UNAIDS estimates that there were 1.0 million female and 770,000 male adolescents living with HIV in 2017 (aidsinfo.unaids.org). The adolescent age group (10 to 19 years) represents a combination [...]

: Introduction: Adolescents and youth receiving antiretroviral treatment (ART) in sub‐Saharan Africa have high attrition and inadequate ART outcomes, and evaluations of interventions improving ART outcomes amongst adolescents are very limited. Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce in developing countries. We measured the effectiveness and cost‐effectiveness of community‐based support (CBS) provided by lay health workers for adolescents and youth receiving ART in South Africa. Methods: A retrospective cohort study including adolescents and youth who initiated ART at 47 facilities. Previously unemployed CBS‐workers provided home‐based ART‐related education, psychosocial support, symptom screening for opportunistic infections and support to access government grants. Outcomes were compared between participants who received CBS plus standard clinic‐based care versus participants who received standard care only. Cumulative incidences of all‐cause mortality and loss to follow‐up (LTFU), adherence measured using medication possession ratios (MPRs), CD4 count slope, and virological suppression were analysed using multivariable Cox, competing‐risks regression, generalized estimating equations and mixed‐effects models over five years of ART. An expenditure approach was used to determine the incremental cost of CBS to usual care from a provider perspective. Incremental cost‐effectiveness ratios were calculated as annual cost per patient‐loss (through death or LTFU) averted. Results: Amongst 6706 participants included, 2100 (31.3%) received CBS. Participants who received CBS had reduced mortality, adjusted hazard ratio (aHR) = 0.52 (95% CI: 0.37 to 0.73; p < 0.0001). Cumulative LTFU was 40% lower amongst participants receiving CBS (29.9%) compared to participants without CBS (38.9%), aHR = 0.60 (95% CI: 0.51 to 0.71); p < 0.0001). The effectiveness of CBS in reducing attrition ranged from 42.2% after one year to 35.9% after five years. Virological suppression was similar after three years, but after five years 18.8% CBS participants versus 37.2% non‐CBS participants failed to achieve viral suppression, adjusted odds ratio = 0.24 (95% CI: 0.06 to 1.03). There were no significant differences in MPR or CD4 slope. The cost of CBS was US$49.5/patient/year. The incremental cost per patient‐loss averted was US$600 and US$776 after one and two years, respectively. Conclusions: CBS for adolescents and youth receiving ART was associated with substantially reduced patient attrition, and is a low‐cost intervention with reasonable cost‐effectiveness that can aid progress towards several health, economic and equality‐related SDG targets., Introduction The UN Sustainable Development Goals (SDGs) are 17 universal, ambitious and interrelated goals established to guide the development policy and agenda of member states till 2030. UNAIDS has also [...]

Introduction: Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. Methods: From 2013 to 2015, a survey using total population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed (n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Results: Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). Conclusions: These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV-related health problems to psychological distress and internalized HIV stigma. This highlights the potential for interventions that do not explicitly target adolescents living with HIV but are sensitive to their needs. Keywords: adolescent; stigma; abuse; shame; HIV/AIDS; structural equation modelling, Introduction There are an estimated 2.1 million adolescents living with HIV (ALHIV) worldwide and 85% of them live in SubSaharan Africa [1]. South Africa is home to the world's largest [...]

Dear Editor: Drug and alcohol abuse are an increasing trend in India since post-independent days. Loss of productivity, increase of crime and violence, spread of AIDS and other sex-related diseases [...]

Background: We evaluated the frequency of hepatitis coinfection in Romanian adolescents who were diagnosed with human immunodeficiency virus (HIV) infection prior to 1995. Methods: One hundred sixty‐one adolescents (13–18 years of age) with symptomatic HIV infection, but without signs of hepatic dysfunction, and 356 age‐matched, HIV‐uninfected controls underwent laboratory testing for markers of parenterally acquired hepatitis virus infection. Results: Seventy‐eight percent of HIV‐infected adolescents had markers of past or present hepatitis B virus (HBV) infection, as compared with 32% of controls (P =.0001). The prevalence of HBV replicative markers was more than 5‐fold higher in HIV‐infected adolescents as compared with controls: 43.4% vs 7.9% (P =.0001), respectively, for hepatitis B surface antigen (HBsAg); and 11.2% vs 2.2% (P =.0001), respectively, for hepatitis B e antigen (HBeAg). The prevalence of HBsAg chronic carriers and the presence of HBV replicative markers was significantly higher in patients with immunologically defined AIDS (CD4+ cell counts < 200 cells/mcL): 59.6% vs 34.6% (P =.02) for HBsAg and 22.8% vs 5.7%, (P =.002) for HBV DNA. After 1 year of follow‐up, the proportion of those who cleared the HBeAg was considerably lower in severely immunosuppressed coinfected patients: 4.7% vs 37.1% (P =.003). Four additional HIV‐infected adolescents became HBsAg‐positive over the term of follow‐up (incidence rate, 24.9/1000 person‐years), despite a record of immunization against hepatitis B. Conclusion: A substantial percentage of HIV‐infected and HIV‐uninfected Romanian adolescents have evidence of past or present HBV infection. In HIV‐infected adolescents, the degree of immunosuppression is correlated with persistence of HBV replicative markers, even in the absence of clinical or biochemical signs of liver disease., Introduction Through the end of 2003, Romania had reported 9936 pediatric HIV/AIDS cases, representing an important part of all European pediatric HIV/AIDS cases. Most of these children became infected with [...]

On March 11-12, 1996, a workshop on how to implement new adolescent immunization (Al) recommendations was held in Atlanta, Ga. Sponsored by the Centers for Disease Control and Prevention, it was a collaborative effort of the National Immunization Program, the Division of Adolescent and School Health/National Center for Chronic Disease Prevention and Health Promotion, and the Hepatitis Branch/National Center for Infectious Diseases. The workshop brought together organizations and individuals interested in adolescent health and immunizations so they could address how new AI recommendations can be implemented most effectively. This article offers an overview of their discussions and suggestions, including issues of cooperation, education, legislation, and AI program development among health provider organizations, health departments, schools, community groups and various other agencies relating to adolescent health services. (J Sch Health. 1997;67(7):304-308), While infant and child vaccination levels are reaching historic levels in the United States, and morbidity and mortality from vaccine-preventable diseases are reaching all time lows for this age group, [...]

Managed care organizations (MCOs) joined local and state public health agencies in a pilot effort to improve hepatitis B immunization rates of adolescents in an urban and a suburban/rural school district. The pilot also explored issues inherent in public and private collaboration on population health improvement Local public health agencies provided links to schools in their communities, took the lead in implementing school-based immunization programs, and provided health education materials. MCOs contributed financial support necessary for the project The final cost per fully vaccinated student, not taking into account the work group's planning and coordination time, was little more than the catalog price of the vaccine alone. Managed care organizations face challenges that complicate their participation and funding of school-based vaccinations: 1) Limited data on health plans of participating students complicate allocation of costs to each MCO; 2) Double-paying occurs for MCOs paying clinics a monthly, per-member rate that already includes adolescent immunizations; 3) When schools provide adolescent immunizations, MCOs lose the 'hook' that draws adolescents to clinics for comprehensive health services. When self-consenting is permitted, schools can achieve a high consent and completion rates for multi-dose adolescent immunizations such as hepatitis B. At the same time, MCOs have the responsibility to provide members with comprehensive care and should continue to examine both internal modifications and external partnerships as opportunities to improve their services to adolescents. (J Sch Health. 1997;67(7):286-289), Three legislative statutes laid the groundwork for collaboration between managed care organizations (MCOs) and public health agencies in Minnesota. MinnesotaCare legislation, which provided improved access to health care for Minnesotans, [...]

The Centers for Disease Control and Prevention funded a three-year demonstration project in San Francisco to assess the feasibility of a large-scale school-based vaccination effort. The project overcame a number of barriers, including lack of pre-existing health services, diversity of home languages, and an every-50-minute-bell schedule. The project targeted seventh graders and all special education students for hepatitis B vaccine (HBVac). Of 4,928 students targeted, 3,509 (71%) consented to vaccination and received the first dose. Of these 3,509 students, 3,256 (93%) completed the three-dose series at school. Key lessons learned include emphasizing a collaborative process in the planning stage, offering an educational component for students, providing an incentive to get timely parental consent, planning distribution and collection of parent materials, and planning vaccination clinics to minimize interrupting the school day. The project clearly demonstrated that, with sufficient attention to political and logistical dimensions, school-based vaccination programs are possible in large urban schools. (J Sch Health. 1997;67(7):269-272), Most people in the United States become infected with hepatitis B virus as adolescents or young adults.[1] Previous recommendations for controlling hepatitis B centered on vaccinating persons in high risk [...]

Every school day, more than 95% of the nation's five- to 17-year-olds attend one of almost 110,000 elementary and secondary schools where they receive instruction in how to avoid major health-threatening behaviors. School is also the place where children and adolescents can be given preventive health care services, including administration of vaccines and monitoring of immunization levels. This article addresses how expanding school health services could improve immunization levels of school-aged youth. (J Sch Health. 1997;67(7):252-255), Every school day, more than 95% of the nation's five- to 17-year-olds attend one of almost 110,000 elementary and secondary schools where they receive instruction in how to avoid major [...]

School-based health care for adolescents provides a convenient and practical way to provide health care to a population at risk for numerous health and mental health problems.[1-3] The constellation of [...]

Byline: Priya Cinna. Durai, Dhanya. Nair Acne vulgaris is a chronic condition affecting more than 85% of adolescents and young adults. It is one of the most common diseases affecting [...]

In the UK, rates of sexually transmitted infection (STI) diagnoses continue to rise among those aged 16-24. In 2004, young women and men accounted for 74 per cent and 56 [...]