Engagement in care among adolescents and young adults living with HIV in Canada

Background: More than thirty years after the beginning of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, HIV continues to be a problem among adolescents and young adults (AYA).. The benefits of combination antiretroviral therapy (cART), including lower morbidity and improved survival, are realized through timely uptake of treatment, virological suppression, and retention in care; however, compared with their adult counterparts, AYA living with HIV tend to have poorer treatment and clinical outcomes. In the current context of UNAIDS’ ambitious 90-90-90 campaign, there is a push to expand cART to all those in need in order to reduce morbidity/mortality and to curb transmission of HIV. We will not achieve the 90-90-90 goals without addressing HIV treatment and outcomes among AYA; however this population remains under-researched; to date there is very little research describing AYA living with HIV in Canada. The overall aim of this dissertation is to examine key cART treatment outcomes among Canadian AYA (ages 18-29 years) living with HIV and compare outcomes with those of older adults (30 years and older). Methods: The quantitative studies in this dissertation utilize clinical and laboratory data from the Canadian Observational Cohort Collaboration (CANOC), Canada’s largest HIV cohort study, which includes data from the year 2000 onward on a total of 10,044 people living in three of Canada’s largest provinces—British Columbia, Ontario, and Quebec. All participants in CANOC are HIV-positive and were cART-naive prior to initiating antiretroviral treatment on or after January 1, 2000. Findings: There are 1168 (13.7%) AYA (ages 18-29 years) in CANOC. Significant differences in treatment outcomes were found between AYA and older adults. AYA were more likely than older adults to initiate cART before their CD4 counts were