Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Abstract

Introduction: The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities.Methods: We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes.Results and discussion: The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed.Conclusions: Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration

“…Among those who had not received treatment, the median duration of follow-up during adolescence was only one year and 52% were LTFU, making reliable ascertainment of mortality difficult in this sub-group. The associations with regional cohort may reflect variations in national infrastructures for HIV and availability of other supportive healthcare services in the context of background country development [2,[25][26][27]. The overall high cumulative incidence of LTFU was concerning.…”

Tracking the transition of adolescents into adult HIV care: a global assessment

“…Data were similarly lacking in much of the Caribbean, Central and South America, Eastern Europe, and the Asia-Pacific. Bailey et al examined transition across these diverse, but largely middle-income settings [ 6 ]. They emphasized the challenges perinatally infected youth face with stigma and socio-economic disparities where HIV epidemics are more often concentrated within key populations.…”

“Because we all have to grow up”: supporting adolescents in Uganda to develop core competencies to transition towards managing their HIV more independently

“…As for other chronic conditions, provision of HIV care during adolescence is characterised by unique management challenges as major cognitive, psychosocial, physical and sexual developmental changes take place [5‐8]. This is illustrated by relatively poorer HIV‐care outcomes with high rates of attrition from clinical care services [9‐11] and compromised ART adherence [10,12,13]. Accompanied by exploration of risk‐associated sexual behaviours [14,15], this has far‐reaching consequences for individuals and public health outcomes alike [16,17].…”

“…Importantly, adolescence involves the shift of responsibility for HIV care, from caregiver to adolescent [18]. To support the development of mechanisms which enable independent self‐management of treatment compliance and health literacy among adolescents, there is a need to characterise the process of successful transition among adolescents, including development of evidence‐based approaches to guide clinicians [10,19]. In high‐burden, resource‐stretched settings, the transition to adult care may not be demarcated by a discrete movement between paediatric and adult facilities as occurs in developed settings [20‐23].…”