Post-transition Care Retention and Viral Suppression Outcomes Among Youth Living with HIV in South Carolina: A Real-World Data Research

Youth living with HIV (YLWH) face substantial challenges following transition from pediatric to adult HIV care, yet evidence on post-transition outcomes in the Southern United States remains limited. Using statewide HIV surveillance and administrative data, we conducted a retrospective cohort study of 493 YLWH in South Carolina (SC) who transitioned to adult care between 2005 and 2021. Retention in adult care was defined as ≥ 2 viral load or CD4 tests at least 6 months apart within one year of the first adult visit, and viral suppression as a last recorded viral load < 200 copies/mL within one year. Multivariable logistic regression assessed individual- and county-level factors associated with retention in adult care and viral suppression, respectively. Overall, 52.7% of YLWH were retained in care and 49.1% achieved viral suppression one-year post-transition. Younger transition age and lower pre-transition CD4 count (≤ 200 cells/mm³) were associated with higher odds of retention in adult care, while higher pre-transition viral load (> 200 copies/mL), men who have sex with men/injecting drug use, heterosexual transmission, and higher socioeconomic vulnerability were associated with lower retention. For viral suppression, Black race, heterosexual transmission, and lower pre-transition CD4 counts were significantly associated with reduced odds of viral suppression. Post-transition outcomes among YLWH in SC remain suboptimal, highlighting the need for targeted, multilevel interventions addressing immunologic vulnerability and socioeconomic disadvantage in the Southern U.S.