More than 20% of new HIV infections in the United States are among youth aged 13 to 24, and more than half of youth living with HIV are unaware of their status. Youth living with HIV have the lowest rates of linkage and retention in care, and are the least likely to have achieved viral suppression. As the Recruitment, Engagement and Retention Center for three studies for HIV-positive and HIV-negative youth in Los Angeles and New Orleans, we aim to recruit and enroll as many youth as possible into interventions that optimize the HIV Treatment and Care Continua. Our enrollment and assessment processes involve rapid, point-of-care testing for HIV and STI in multiple sites (pharyngeal, vaginal and anal) as well as immediate referrals not only for treatment, but Pre- and Post-Exposure Prophylaxis (PrEP/PEP), housing, mental health, and substance use treatment programs as well.

1. UCLA Adolescent Medicine Trials Network
CARES:
Comprehensive Adolescent Recruitment &
Engagement Studies

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4. 3 Integrated Studies
● Study 1: Acute Infection
○ 36 acute infections + 36 established, treatment-naïve YLH
● Study 2: HIV+ Youth
○ 220 in a RCT of Stepped-Care
● Study 3: HIV- Youth
○ 1500 in a RCT of eTechnologies

6. Cross-Cutting Themes
● Same interventions tailored to HIV+ & HIV- youth
● Technology-focused with paraprofessionals
● Evidence-based practices (EBP), not manualized EBI
● Replicate with flexibility based on common features, skills, and
components of EBI
● Test of the CDC recommended interventions: repeat testing & sustained
follow-up; care linkage; including costs

7. % Linked
to care
PRIMARY HIV PREVENTION
HIV Prevention/Treatment Framework
% Assessed
for risks and
needs
%
Engaged,
retained
and
adherent
% Linked to
prevention
services
INITIAL HIV TESTING
PositiveNegative
% Negative
(Primary
prevention
success)
% Positive
(Primary
prevention
failure)
Retesting for HIV
%
Diagnosed
% Virally
suppressed
%
Retained
in care
SECONDARY HIV PREVENTION
HIV Prevention Continuum
HIV Treatment Continuum
Horn T et al. Journal of the International AIDS Society 2016, 19:21263

9. Seronegative Youth Demographics n=554
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Transgender
Unprotected contact with PLWH (in 12 m)
STD (in past 12 m)
SA Tx
Sex exchange (in past 12 m)
LGB
Mental health hospitalization
Criminal system contact
Unprotected sex (in past 12 m)
Homeless history
Black/Latino

10. Community-based Agencies

11. Engaging Youth Through Various Methods

12. Challenges

13. What has Worked?
● FLEXIBILITY
● Multi-faceted retention approach
● On-site treatment of STIs
● Rolling start of new sites
● Team building
● One-on-one supervision
● Real-time data collection
● Hiring from within the target population

15. Maryann Koussa
UCLA ATN Cares
mkoussa@mednet.ucla.edu