HIV Care Continuum Outcomes among Adolescents and Young Adults Living with HIV in Latin America and the Caribbean: Association with Depression and Substance Use

Background Adolescents and young adults with HIV (AYAWH) represent vulnerable populations, with increased risk of virologic failure, loss to follow-up, and death. Depression and substance use in AYAWH can lead to worse outcomes, yet this overlap is not well understood. Methods This cross-sectional study included adolescents (10-17 years) and young adults (18-24 years) with HIV in the Caribbean, Central and South America network for HIV epidemiology (CCASAnet). Participants were administered surveys to assess for depression, substance use, and antiretroviral therapy (ART) adherence. Risk factors for depression; alcohol, tobacco, and substance use; missing ART doses; viral suppression; and 1-year retention were assessed. Results Six hundred twenty-five AYAWH were included. Depression prevelance was 16%. Males (adjusted odds ratio [aOR], 0.26; 95% CI, 0.16-0.44) and younger youth (15-year-olds vs 18-year-olds: aOR, 0.61; 95% CI, 0.40-0.95) were less likely to have depression. Fifty-eight percent reported using alcohol, 28% reported tobacco use, 17% reported cannabis use, and 4% reported cocaine use. Forty-one percent missed 1 or more doses of ART in the past week. Forty percent had detectable viral loads at the time of survey completion. Those who acquired HIV perinatally were more likely to have an unsuppressed viral load (aOR, 2.4; 95% CI, 1.24-4.62; P =. 009). Only 73% of participants were retained in care following the survey; there was no statistical association between retention and age, sex, education, probable route of HIV acquisition, depression, and needing intervention for substance use. Conclusions Substance use and depression were prevalent in AYAWH, as were missed doses of ART and detectable viral loads.