Atlanta's Ponce de Leon Center currently addresses the needs of about 500 HIV-infected infants, children, adolescents, and young adults in partnership with the Grady Infectious Diseases Program (IDP). Of the young people served, 88 percent are African American, 5 percent are Hispanic, and 83 percent receive Medicaid. Established at Grady Memorial Hospital in 1986, the PFYC moved to the Ponce de Leon Center in 1993. Together, the PFYC and Grady IDP constitute the largest stand-alone facility for adult, pediatric, and adolescent HIV care in the United States.

The Ponce de Leon Center provides one-stop shopping for its clients, which is a significant convenience when multiple family members are receiving care. It houses a primary care clinic serving men and women, a family clinic that treats mothers along with their children, and AIDS-related organizations and services. For example, Project Open Hand, an agency that provides meals for people living with HIV; AID Atlanta, a case management service; and an office of the Department of Family and Children Services all have a presence at the Ponce de Leon Center. In addition, the Center includes a dental clinic, a mental health clinic, a research area for clinical drug trials, and an infusion area where intravenous therapies are administered on an outpatient basis. A subspecialty clinic provides consultations in ophthalmology, dermatology, neurology, hematology and oncology, and palliative care. A perinatal substance abuse clinic cares for pregnant women who are using drugs and are at risk for contracting HIV. To ensure age appropriate and developmentally appropriate care, clinicians receive ongoing training through journal clubs, conferences, and hands-on learning. 

An important aspect of the Center's program is to provide care to young adults up to the age of 25. Generally, young adults can be a difficult population to reach when it comes to health care. This challenge can be compounded by the stigma associated with HIV. The Center employs multiple strategies to support adherence and help their young patients remain in care. Case management and mental health services are tailored to the needs of young adults. Peer support groups are also an important form of support for patients. The groups are led by a social worker or psychologist. In the groups, patients who are doing well in terms of adherence to treatment are asked to discuss their strategies with their peers. In addition to adherence, participants discuss issues that are relevant to young adults such as education, housing, and employment options.

The Center has a process in place to transition patients to adult care. A critical aspect of this process is introducing the concept of transition early on so that patients are prepared when the time comes. If possible, the adult care providers are identified prior to transition so that patients have an opportunity to meet them. An advantage of the Center's co-located services is that the young adults can continue to receive care at the same facility after they transition.

In May, Dr. Rana Chakraborty, Dr. Andres Camacho-Gonzalez, and Ashley Boylan of the Ponce Family and Youth Clinic discussed their program during an in+care Campaign webinar. The archived webinar provides more detail on the program. 

Minniear, T.D., Gaur, A.H., Thridandapani, A. et al. Delayed entry into and failure to remain in HIV care among HIV-infected adolescents. AIDS Research and Human Retroviruses 2013; 29(1): 99-104.

In this article the researchers examine factors associated with HIV-infected adolescents who delayed entry into HIV care after diagnosis and the failure to remain in care. The researchers reviewed the clinical records for 202 adolescents (13-21 years old) infected with HIV via high-risk behaviors receiving services at St. Jude Children's Research Hospital, which operates a large, urban, comprehensive pediatric/adolescent HIV clinic in Memphis, Tennessee.

Delayed entry to care occurred in 38 percent of the subjects and failure to remain in care occurred in 29 percent. Factors associated with delayed entry included lack of a stable residence, being enrolled in college, and residing within five miles of the clinic- a finding that indicates that proximity and even free transportation do not have an effect on engagement with this population. The researchers suggest that the disruptions associated with unstable housing may impact engagement. With college students-who were four times more likely to delay entry into care-the researchers suggest that delays may result from the demands of an academic schedule, fear of being stigmatized, or the lack of a guardian's influence.

Once in care, college students were more likely to remain in care than high school students and those who did not complete high school. The researchers speculate that college students may have a better understanding of the concepts of HIV care that were explained during clinical visits or have greater self-motivation. Compared with adolescents with private insurance, those without insurance were more likely to fall out of care-even though the clinic offers care free of charge. It is important to note that those patients who remained in care showed slightly greater improvements in CD4+ cell count and significantly larger reductions in viral load at their last clinic visit than those that were lost to care.

The researchers suggested that interventions that address these factors can play a role in supporting early engagement in care and retention in care.