Health outcomes and the transition experience of HIV-infected adolescents after transfer to adult care in Québec, Canada

Kakkar, Fatima; Linden, Dimitri Van der; Valois, Silvie; Maurice, François; Onnorouille, Marion; Lapointe, Normand; Soudeyns, Hugo; Lamarre, Valérie

doi:10.1186/s12887-016-0644-4

Cited by 61 publications

(77 citation statements)

References 25 publications

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“…While the prominence of age is not necessarily surprising, having been highlighted in other studies [34, 47], these findings do emphasize that tailored, age- and developmental appropriate transition should recognize the evolving capacity of adolescents [45]. This may have a gender-implication given that female adolescents, who generally mature earlier than their male counterparts were older in this study.…”

Section: Discussionsupporting

confidence: 61%

Transition into adult care: factors associated with level of preparedness among adolescents living with HIV in Cambodia

Ngin²,

Pal³

et al. 2017

AIDS Res Ther

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BackgroundPreparing adolescents for transition into adult care and supporting their acquisition of self-health care management skills is a critical determinant of their post-transition HIV care outcomes. However, there is a scarcity of research on effective transition strategies. This study explores factors associated with adolescent preparedness for transition into adult care in Cambodia.MethodsIn August 2016, a cross-sectional study was conducted among 223 adolescents living with HIV aged 15–17, randomly selected from 11 antiretroviral therapy clinics, utilizing a structured questionnaire. The level of preparedness was determined using a pre-existing scale, and adolescents were categorized as having a high- or low level of preparedness for transition. Bivariate and multivariate analyses were conducted.ResultsOf 223 adolescents, 55.2% were male, and their mean age was 15.8 years. Overall, 53.3% had a high level of preparedness for transition. As part of the transition protocol, 2.7% had completed a transfer form, 24.7% had a transition case manager, 29.6% had been counselled about the transition, and 19.7% had visited an adult ART clinic. In multivariate analysis, a higher level of preparedness for transition was independently associated with older age (AOR 2.44, 95% CI 1.34–4.46; p = 0.004), family having received social support for their health (AOR 5.32, 95% CI 1.97–14.36; p = 0.001), knowing the kind of treatment they received (ART) (AOR 12.67, 95% CI 2.91–15.19; p = 0.001), trust in friends or family for HIV treatment (AOR 7.82, 95% CI 1.13–8.89; p = 0.008), receiving counseling on transition (AOR 3.17, 95% CI 1.15–8.76; p = 0.03), having a ‘Case Manager’ identified to support them during the preparation process for transition (AOR 3.89, 95% CI 1.08–13.96; p = 0.04), and satisfaction with preparation process for transition in general (AOR 0.35, 95% CI 0.03–0.87; p = 0.01).ConclusionsA range of individual, social and health system and services factors may determine successful transition preparedness among adolescents in Cambodia. Strengthening implementation of age-appropriate and individualized case management transition at all sites, while creating supportive family, peer, and healthcare environments for adolescent transition is required.

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Section: Discussionsupporting

confidence: 61%

Transition into adult care: factors associated with level of preparedness among adolescents living with HIV in Cambodia

Ngin²,

Pal³

et al. 2017

AIDS Res Ther

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“…In a study conducted among perinatally infected adolescent and youth in the UK, 16-20-year olds treated in adult care were found to have significantly higher mortality compared to 13-15-year olds treated in paediatric care (rate ratio 2.7; 95% CI 0.6-12.2) [17]. A recent study conducted in Canada reported that a quarter of transitioned patients were no longer engaged in care [55]. Although these data are from high-income settings, we may expect similar findings in low-resource settings where report of transition outcomes are less common [48,50].…”

Section: Discussionmentioning

confidence: 99%

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Dahourou

Gautier-Lafaye

Teasdale

et al. 2017

Journal of the International AIDS Society

110

145

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Introduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition.Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10–24 years with information on transition were eligible.Results: Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older adults. There is a need to identify sub-groups at higher risk of loss to follow-up for targeted care and peer support.Expert commentary: Although the available HIV-related data on adolescent transition outcomes are limited, there is evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa.

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“…However, in much of sub-Saharan Africa, where HIV care is implemented at primary healthcare clinics, there is no separation in paediatric and adult services and thus no need for transition of care [16]. Nevertheless, transition to adulthood still presents challenges for optimal HIV disease management as adolescent health needs evolve and autonomy for their own self care is necessary [17]. Many of these challenges are shared by both vertically and horizontally infected adolescents, although their disease progression and severity during adolescence may differ [18,19].…”

Section: Introductionmentioning

confidence: 99%

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Slogrove

Mahy

Armstrong

et al. 2017

Journal of the International AIDS Society

119

101

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Introduction: With increasing survival of vertically HIV‐infected children and ongoing new horizontal HIV infections, the population of adolescents (age 10–19 years) living with HIV is increasing. This review aims to describe the epidemiology of the adolescent HIV epidemic and the ability of national monitoring systems to measure outcomes in HIV‐infected adolescents through the adolescent transition to adulthood.Methods: Differences in global trends between younger (age 10–14 years) and older (age 15–19 years) adolescents in key epidemic indicators are interrogated using 2016 UNAIDS estimates. National population‐based survey data in the 15 highest adolescent HIV burden countries are evaluated and examples of national case‐based surveillance systems described. Finally, we consider the potential impact of adolescent‐specific recommendations in the 2016 WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.Discussion: UNAIDS estimates indicate the population of adolescents living with HIV is increasing, new HIV infections in older adolescents are declining, and while AIDS‐related deaths are beginning to decline in younger adolescents, they are still increasing in older adolescents. National population‐based surveys provide valuable estimates of HIV prevalence in older adolescents and recent surveys include data on younger adolescents. Only a few countries have nationwide electronic case‐based HIV surveillance, with the ability to provide population‐level data on key HIV outcomes in the diagnosed population living with HIV. However, in the 15 highest adolescent HIV burden countries, there are no systems tracking adolescent transition to adulthood or healthcare transition. The strength of the 2016 WHO adolescent‐specific recommendations on antiretroviral therapy and provision of HIV services to adolescents was hampered by the lack of evidence specific to this age group.Conclusions: Progress is being made in national surveillance and global monitoring systems to specifically identify trends in adolescents living with HIV. However, HIV programmes responsive to the evolving HIV prevention and treatment needs of adolescents can be facilitated further by: data disaggregation to younger and older adolescents and mode of HIV infection where feasible; implementation of tools to achieve expanded national case‐based surveillance; streamlining consent/assent procedures in younger adolescents and consensus on indicators of adolescent healthcare transition and transition to adulthood.

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Health outcomes and the transition experience of HIV-infected adolescents after transfer to adult care in Québec, Canada

Cited by 61 publications

References 25 publications

Transition into adult care: factors associated with level of preparedness among adolescents living with HIV in Cambodia

Transition into adult care: factors associated with level of preparedness among adolescents living with HIV in Cambodia

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

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