image: Xueying Yang is an assistant professor of health promotion, education, and behavior at the University of South Carolina's Arnold School of Public Health.
Credit: Anna Wippold
Assistant professor of health promotion, education, and behavior Xueying Yang has been awarded another $400K NIH grant to support her HIV research – this time from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. She will use the R21 funding to study the transition of youth living with HIV to adult-oriented care.
“Due to advances in antiretroviral therapy, the vast majority of youth living with HIV in the U.S. now survive to adulthood, and, thus, must transition from pediatric to adult HIV care,” says Yang, who is an investigator with the South Carolina Center for Healthcare Quality and the USC Big Data Health Science Center. “This successful transition is a pressing public health issue that impacts ongoing efforts to end the HIV epidemic in the U.S., yet this shift encompasses many challenges.”
Transitioning from pediatric-to-adult HIV care involves forming new relationships with providers and taking on greater agency and independence in care. Behavioral, developmental and contextual challenges can make navigating these changes difficult – leading to disengagement in care, poor antiretroviral therapy adherence and increasing viral loads. Teens who are members of sexual, gender, racial, and/or ethnic minority groups face additional barriers related to stigma and discrimination.
Despite advances in HIV detection and treatment, infection rates among adolescents and young adults (ages 13 to 24) have doubled in the past 15 years. This group now accounts for 21 percent of all people living with HIV in the U.S. and requires special attention to reverse these rates and ensure care that prevents the spread and progression of the illness.
With no uniform transition protocol currently in place, Yang and her team will be the first to study this process. Using data collected by the South Carolina Department of Environmental Health and Control and six other state agencies, they will analyze electronic health records for the estimated 6,000 South Carolinians who were diagnosed between 2005 and 2023 and who were or are a part of this age group.
Specifically, they will look at pediatric-to-adult transition status (e.g., successful, delayed, or loss/failure in transition) and post-transition care outcomes (e.g., retention in adult care, viral suppression in adult care). They will also identify facilitators and barriers of successful transition by modeling individual (e.g., mental health, substance use) and contextual (e.g., socioeconomic status, health care access).
“Our in-depth assessments of pediatric-to-adult care transitions among youth living with HIV in South Carolina will help us identify which youth are more vulnerable to delayed or failed transition,” Yang says. “It will also enable us to develop guidance to help policy makers and service providers improve systems and protocols to better support this population and to advise state health departments on targeted invention strategies to help disadvantaged youth living with HIV maintain continuous engagement in care, manage their disease and decrease mortality rates and other complications for these youth.”