Optimizing HIV transition services for young adults

Abstract

The complex needs of this generation are well described and whilst examples of good practice are emerging, how best to support their transition to adulthood requires carefully tailored studies of cost-effective interventions that can be up scaled in resource limited settings.

Retention and adherence

“…Viral suppression in pediatric care and shorter time between last pediatric and first adult appointment were associated with retention on suppressive ART in adult services [32**]. While transfer between pediatric and adult services has been highlighted as a particular barrier to retention, half of this cohort had disengaged from pediatric care prior to reenrolling in adult care, highlighting the complexity of disentangling the impact of service change from the multiple physical, psychosocial and economic challenges during adolescence [33]. Linked data for 271 PHIV British youth tracked from pediatric to adult care showed a decline in CD4 counts prior to transfer; after transfer, counts continued to decline in black males, remained constant in white males and black females, and increased in white females [34*].…”

“…Age at transfer and moving hospital had no apparent impact, however more recent calendar year was associated with better outcomes, potentially reflecting improvements in ART and/or transition over time. Transition typically occurs during late adolescence in Europe, often extending into young adulthood in the US [33]. Populations vary by route of transmission; with predominantly PHIV in Europe and a larger proportion of BHIV in US cohorts.…”

Cancer in adolescents and young adults living with HIV

“…Lastly, the period of transition of health care between paediatric and adult services is associated with poorer health outcomes in many chronic diseases, including HIV [14]. Global models of transition vary widely between countries, income settings and individual diseases and an adolescent living with HIV and a previous or current cancer diagnosis may have to negotiate two independent transition processes [15,16]. For young people living with HIV, transition typically occurs during late teens or early 20s, an age with peak incidence in Hodgkin lymphoma diagnoses within the general population [16–18].…”

Transition from pediatric to adult care for adolescents living with HIV in South Africa: A natural experiment and survival analysis

“…Neurocognitive, developmental, and social differences among perinatally-HIV infected adolescents makes age-based transition problematic [ 29 , 30 ]. Given the number of barriers to successful transition, transition readiness assessments could assist clinicians in determining when adolescents should transition to adult care rather than based on age alone [ 31 ]. Transition readiness assessments for chronic illnesses in other settings have been used to assist with transition, but have not been used in sub-Saharan Africa [ 32 , 33 ].…”