To date, 33 youth have been enrolled into the REACH study here at The Children's Hospital of Philadelphia. The breakdown of these subjects who are still enrolled is as follows: fifteen infected females, five uninfected females, five infected males, and three uninfected males. Four enrolled subjects have come off study, three uninfected females and one infected male. The infected subject who has left the study was relocated to a facility in Texas where there is not a REACH site. To enhance retention in the study, several strategies are in place. First, the frequency of home visits is increasing in order to maintain interest and adherence. In addition, the new social worker/case manager is focussed completely on those youth engaged in care, with all outreach coordinated by a different individual. The majority of youth who have left the study have been uninfected control females. To address this problem, the study team is working closely with other groups who are working with high-risk youth to identify youth who have demonstrated some adherence to medical visits, many of whom already have a relationship with a provider at this institution. Several plans are in place to enhance recruitment and retention. First, Project ACCESS will hope to get more youth engaged in HIV counseling and testing. The outreach staff has been increased and will focus on more direct street outreach as well as ongoing conversations with providers in the community, many of whom have already referred youth for REACH. Maintaining youth in the protocol is a major goal of the study team. Besides more intensive home visitation and case management, some unique programs are beginning or under development. As mentioned, we have received other funding to provide a Life Directions program doing intensive work with youth around school and vocational rehabilitation. The coordinator of the program meets with the youth in the clinic, discusses the program, and encourages youth to participate. The hope of this program is to give these youth goals and dreams for their lives and the support and development needed to achieve them. This is a program to change the fatalistic attitude of many youth which, in turn, will hopefully help adherence. The social worker along with one of the peer educators is developing an extension of the Life Directions program to work with youth in a group setting to discuss such issues as clinic visit adherence, medication compliance, nutrition, substance use issues, etc. The Peer Educator is a young man who is also infected with HIV and has personally confronted all of these issues. The hope is that these groups, along with individual counseling, will help youth to not only see the benefits of care but also to look at their lives critically and develop individual plans and strategies for better adherence to medical Regimens.
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