Association of Perceived Social Support with Viral Suppression Among Young Adults with Perinatally-Acquired HIV in the US-based Pediatric HIV/AIDS Cohort Study (PHACS)

Abstract

Purpose

To determine the relationship between perceived social support and viral suppression among young adults with perinatally-acquired HIV (YAPHIV).

Participants and Methods

We included YAPHIV ≥18 years enrolled in AMP Up, a study of PHACS (Pediatric HIV/AIDS Cohort Study), with social support evaluations and ≥1 HIV viral load (VL) measured over the next year. We evaluated emotional, instrumental, and friendship social support via the NIH Toolbox. We defined social support, measured at study entry and year 3 (if available), as low (T-score ≤40), average (41–59) or high (≥60). We defined viral suppression as all VL <50 copies/mL over the one year after social support measures. We fit multivariable Poisson regression models using generalized estimating equations, and evaluated transition from pediatric to adult care as an effect modifier.

Results

Among 444 YAPHIV, low emotional and instrumental support and friendship at entry were reported by 37%, 32% and 36%. Over the next year, 44% were virally suppressed. Of 136 with year 3 data, 45% were suppressed. Average or high levels of all three social support measures were associated with higher likelihood of viral suppression. Instrumental support was associated with viral suppression among those in pediatric (adjusted proportion suppressed among those with average/high vs low support=51.2% vs 28.9%; risk ratio (RR)=1.77, 95% confidence interval (CI)=1.37, 2.29), but not adult care (40.0% vs 40.8%; RR=0.98, 95% CI=0.67, 1.44).

Conclusion

Sufficient social support increases likelihood of viral suppression among YAPHIV. Strategies to enhance social support may promote viral suppression as YAPHIV prepare for adult clinical care transition.

Keywords:

• social support
• perinatal HIV
• young adults
• viral suppression
• clinical care transition

Acknowledgments

We thank the participants and families for their participation in PHACS, and the individuals and institutions involved in the conduct of PHACS. The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Institute of Dental and Craniofacial Research, the National Cancer Institute, the National Institute on Alcohol Abuse and Alcoholism, the Office of AIDS Research, and the National Heart, Lung, and Blood Institute through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) (Principal Investigator: George R Seage III; Program Director: Liz Salomon) and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co-Principal Investigator: Ellen Chadwick; Project Director: Patrick Davis). Data management services were provided by Frontier Science and Technology Research Foundation (PI: Suzanne Siminski), and regulatory services and logistical support were provided by Westat, Inc (PI: Julie Davidson).

The following institutions, clinical site investigators and staff participated in conducting PHACS AMP and AMP Up in 2019, in alphabetical order: Ann & Robert H. Lurie Children’s Hospital of Chicago: Ellen Chadwick, Margaret Ann Sanders, Kathleen Malee, Yoonsun Pyun; Baylor College of Medicine:, Mary Paul, Shelley Buschur, Chivon McMullen-Jackson, Lynnette Harris; Bronx Lebanon Hospital Center: Murli Purswani, Mahboobullah Mirza Baig, Alma Villegas; Children’s Diagnostic & Treatment Center: Lisa- Gaye Robinson, Sandra Navarro, Patricia Garvie; Boston Children’s Hospital: Sandra K. Burchett, Rebecca Pinsky, Adam R. Cassidy; Jacobi Medical Center: Andrew Wiznia, Marlene Burey, Ray Shaw,; Rutgers - New Jersey Medical School: Arry Dieudonne, Linda Bettica, Juliette Johnson, Karen Surowiec; St. Christopher’s Hospital for Children: Janet S. Chen, Taesha White, Mitzie Grant; St. Jude Children’s Research Hospital: Katherine Knapp, Jamie Russell-Bell, Megan Wilkins, Erick Odero; San Juan Hospital Research Unit/Department of Pediatrics, San Juan Puerto Rico: Midnela Acevedo-Flores, Heida Rios, Vivian Olivera; Tulane University School of Medicine: Margarita Silio, Medea Gabriel, Patricia Sirois; University of California, San Diego: Stephen A. Spector, Megan Loughran, Veronica Figueroa, Sharon Nichols; University of Colorado Denver Health Sciences Center: Elizabeth McFarland, Carrie Chambers, Emily Barr, Mary Glidden; University of Miami: Gwendolyn Scott, Grace Alvarez, Juan Caffroni, Anai Cuadra.

Dr. Tassiopoulos had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Note: The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services.

*Dedicated to Dr. George Richard Seage III (1957-2021).

Disclosure

Dr Katherine Tassiopoulos, Ms Yanling Huo, Dr Deborah Kacanek, Dr Sharon Nichols and Dr Russell B Van Dyke report grants from the National Institutes of Health, during the conduct of the study; grants from the National Institutes of Health, outside the submitted work. Dr Kathleen Malee reports grants from the National Institutes of Health, during the conduct of the study. Dr Stephan Kohlhoff reports grants from the National Institutes of Health, during the conduct of the study; grants from Pfizer, grants from DiaSorin, outside the submitted work. The authors report no other conflicts of interest in this work.