Easing the Transition of HIV-Infected Adolescents to Adult Care

Abstract

The past two decades have witnessed dramatic reductions in HIV-related morbidity and mortality following the introduction of combination antiretroviral therapy (cART) for infants and children. Improved therapeutic outcomes have changed the face of the HIV epidemic and with it the needs of patients and families. Consequently, many perinatally-and behaviorally-infected adolescents are now transitioning to adult care. What follows is a brief review and commentary concerning original research, reviews, and clinical guidelines describing challenges and best practices in facilitating care transitions for HIV-infected youth to adult care. Over 25,000 HIVinfected US youth aged 13-24 years will require transition to adult care within the next decade. Transition planning must address issues of cognitive development and mental health, medication adherence, sexuality, reproductive, and gender identity, socioeconomic and health insurance status, stigma and disclosure, disrupted relationships with pediatric care providers, and communication. Clinical experience with HIV and other chronic illnesses supports a multidisciplinary, developmentally-sensitive approach to meeting the challenges inherent in care transition that begins early and is monitored with regular evaluation and revision.

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

“…This transition planning ideally would address issues inherent in adolescent health including mental health, medication adherence, sexuality, reproductive health, gender identity, socioeconomic and health insurance status, stigma, disclosure, and disrupted relationships. 97 In addition, poor adherence among youth contributes to low viral suppression in those accessing treatment. There is no simple solution to improve adherence among youth.…”

The Effects of a Mass Media HIV-Risk Reduction Strategy on HIV-Related Stigma and Knowledge Among African American Adolescents

“…The National Alliance for State and Territorial AIDS Directors and National Coalition of STD Directors (2014) highlight the salience of HIVrelated stigma in undermining proven-effective HIV-reduction strategies. 4 Stigma not only impedes preventive behavior, 5,6 it also reduces testing, 5,7 treatment, 5,8 linkage, 9,10 retention, 9,10 and quality of care for persons living with HIV/AIDS (PHA). 11,12 It also increases the risk of negative mental health outcomes (i.e., depression and anxiety) for PHA.…”

Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

“…More than 25000 HIV-infected individuals aged 13-24 years old are currently undergoing the transition to adult outpatient care in the United States [61] . For this transition to be successful, the focus must fall on comprehensive care, including the patients' mental and reproductive health, gender identity, sexuality, stigmas, social issues, cognitive development, adherence to ART, detachment from pediatric outpatient care, and communication with the staff in charge of patient care [61][62][63] . Integral care poses a major challenge; however, it is crucial for the management of this population of patients to reduce the impact of the transition and improve their long-term follow-up.…”