The Transition of Care From Pediatric to Adult Health-Care Services of Vertically HIV-Infected Adolescents: A Pilot Study

Abstract

Clinical and psychological HIV-related problems peak during adolescence, which coincides with transition of children and adolescents infected from mothers from pediatric to adult reference centers for HIV infection. Transition often is done without specific programs. We wanted to explore transition as an opportunity to increase the efficacy of care and the psychological well-being through a specific program. Methods: Thirteen vertically infected patients aged 13-20 years were followed up for 24 months by pediatricians, infectious disease specialists, a psychologist, and a nurse. Interventions consisted in joint clinic, simplification of therapy, patient group discussions, HIV infection explanations, and psychological support, lasting 12 months. Efficacy was measured by viro-immunological outcomes and adherence to therapy and psychological tests. Clinical, viro-immunological, and psychological evaluations were performed at 0 (T0) and 12 months (T12) and 6 months after transition to an adult center (T18). Psychological outcomes were assessed using standardized questionnaires for quality of life and self-esteem. Results: In 11/13 participants, pills administrations/day were significantly reduced. Patients with undetectable viral load and CD4+ >25% increased from 61 to 77% and from 61 to 74%, respectively. Six months after transition, all patients exhibited an undetectable viral load. Adolescents' awareness of the severity of the disease and the risk of sexual transmission was generally poor. Patients classified with "severe" psychological distress according to the quality of life index decreased from 38 to 15% and well-being increased. Similar results were observed 6 months after the transition to adult care. No effect was observed on self-esteem index. Conclusions: Specific protocols for transition should be developed to optimize resilience and psychological well-being, including routine psychological support for adolescents with HIV infection transiting from pediatric to adult centers for HIV infection.

Transition Interventions for Adolescents on Antiretroviral Therapy on Transfer from Pediatric to Adult Healthcare: A Systematic Review

“…The year of publication of included studies ranged from 2014 to 2020. Most studies ( n = 5) were conducted in high-income countries: two in Italy [ 23 , 24 ] and the United States of America [ 25 , 26 ] and one in Sweden [ 27 ]. The remaining two studies [ 28 , 29 ] were conducted in Thailand, an upper-middle-income country [ 30 ].…”

“…For the first study [ 24 ], the pre-transition intervention involved complete clinical, immunological and virological evaluations. Data on disease knowledge, adherence to therapy and psychological status (including self-esteem) were gathered from adolescents who already knew their HIV status.…”

“…A steady flow of communication between patients/pediatric or adolescent healthcare givers and adult clinic specialists was emphasized in four studies [ 23 , 24 , 28 , 29 ]. This was noted to give adolescents a voice in the programs and enhance the efficient transitioning process between pediatric/adolescent clinic staff and the adult clinic staff.…”

“…Three studies [ 23 , 24 , 28 ] incorporated psychological support for adolescents and their families in their approach to effective transition from pediatric to adult health care. One study provided psychological support by meeting needs associated with diagnosis disclosure, HIV acceptance, the weight of living with a chronic disease and demanding family structures or dynamics [ 23 ].…”

“…One study provided psychological support by meeting needs associated with diagnosis disclosure, HIV acceptance, the weight of living with a chronic disease and demanding family structures or dynamics [ 23 ]. The second study, on the other hand, was psychologically supported by conducting an individual meeting once a month by a psychologist knowledgeable in pediatric HIV infection management to adolescents [ 24 ]. Additionally, group meetings were conducted with all adolescents and their families twice a year.…”