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

Sohn, Annette H.; Vreeman, Rachel C.; Judd, Ali

doi:10.7448/ias.20.4.21878

Cited by 15 publications

(14 citation statements)

References 14 publications

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“…The paucity of written protocols highlights the lack of well-established, evidence-informed guidelines for adoption and use at the facility level. Our findings are consistent with what prevails in many other sub-Saharan African countries [ 35 – 38 ] explained in part by the lack of clinic infrastructure and adolescent health-trained staff [ 35 ]. However, transition has been noted to be a somewhat newer concept particularly in Nigeria’s sub-region of West and Central Africa, in part due to the predominance of family-centered care models in this region’s public health sector [ 35 ].…”

Section: Discussionsupporting

confidence: 91%

“…This would explain the observed peak at 15 years for transfer; the second peak at age 18 years is most likely due to the attainment of legal age and/or delayed ALHIV transfers to adult clinics at facilities with established adolescent HIV clinics. While chronological age appears to be a strong transfer criterion, it is also critical to consider readiness by age of maturity of the patient, which may vary depending on level of social support, education, and learning capabilities[ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Pediatric to adult healthcare transitioning for adolescents living with HIV in Nigeria: A national survey

Badejo¹,

Menson

Sam-Agudu

et al. 2018

PLoS ONE

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IntroductionThe period of transition from pediatric to adult care has been associated with poor health outcomes among 10–19 year old adolescents living with HIV (ALHIV). This has prompted a focus on the quality of transition services, especially in high ALHIV-burden countries. Due to lack of guidelines, there are no healthcare transition standards for Nigeria’s estimated 240,000 ALHIV. We conducted a nationwide survey to characterize routine transition procedures for Nigerian ALHIV.Materials and methodsThis cross-sectional survey was conducted at public healthcare facilities supported by five local HIV service implementing partners. Comprehensive HIV treatment facilities with ≥1 year of HIV service provision and ≥20 ALHIVs enrolled were selected. A structured questionnaire assessed availability of treatment, care and transition services for ALHIV. Transition was defined as a preparatory process catering to the medical, psychosocial, and educational needs of adolescents moving from pediatric to adult care. Comprehensive transition services were defined by 6 core elements: policy, tracking and monitoring, readiness evaluation, planning, transfer of care, and follow-up.ResultsAll 152 eligible facilities were surveyed and comprised 106 (69.7%) secondary and 46 (30.3%) tertiary centers at which 17,662 ALHIV were enrolled. The majority (73, 48.3%) of the 151 facilities responding to the “clinic type” question were family-centered and saw all clients together regardless of age. Only 42 (27.8%) facilities had an adolescent-specific HIV clinic; 53 (35.1%) had separate pediatric/adolescent and adult HIV clinics, of which 39 (73.6%) reported having a transfer/transition policy. Only 6 (15.4%) of these 39 facilities reported having a written protocol. There was a bimodal peak at 15 and 18 years for age of ALHIV transfer to adult care. No surveyed facility met the study definition for comprehensive transition services.ConclusionsFacilities surveyed were more likely to have non-specialized HIV treatment services and had loosely-defined, abrupt transfer versus transition practices, which lacked the core transition elements. Evidence-based standards of transitional care tailored to non-specialized HIV treatment programs need to be established to optimize transition outcomes among ALHIV in Nigeria and in similar settings.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Pediatric to adult healthcare transitioning for adolescents living with HIV in Nigeria: A national survey

Badejo¹,

Menson

Sam-Agudu

et al. 2018

PLoS ONE

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“…Scale‐up of anti‐retroviral therapy (ART) has enabled an increasing number of young adults living with HIV (YLWH) to survive into adolescence and adulthood . In addition to the physical, emotional and psychosocial challenges all adolescents face, YLWH face distinct challenges such as commencement or continuation of lifelong ART, drug side‐effects, retention in care, disclosure and mental health challenges associated with living with a stigmatizing chronic disease . These challenges influence adolescents’ quality of life and social relationships making them more prone to high‐risk behavior and poor ART adherence, thereby increasing their susceptibility to disease complications and mortality .…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the physical, emotional and psychosocial challenges all adolescents face, YLWH face distinct challenges such as commencement or continuation of lifelong ART, drug side‐effects, retention in care, disclosure and mental health challenges associated with living with a stigmatizing chronic disease . These challenges influence adolescents’ quality of life and social relationships making them more prone to high‐risk behavior and poor ART adherence, thereby increasing their susceptibility to disease complications and mortality . Compared to children and adults, adolescents have worse ART adherence, lower rates of virologic suppression and higher rates of viral rebound after an initial period of suppression .…”

Section: Introductionmentioning

confidence: 99%

Challenges and facilitators of transition from adolescent to adult HIV care among young adults living with HIV in Moshi, Tanzania

et al. 2019

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Introduction Scale up of anti‐retroviral therapy has enabled millions of children infected with HIV to survive into adulthood, requiring transition of care to the adult HIV clinic. This transition period is often met with anxiety and reluctance. Youth who fail to transition may create strain on capacity in the pediatric and adolescent clinics or result in individuals dropping out of care entirely. This study examined challenges and facilitators to the transition among young adults living with HIV in Moshi, Tanzania. Methods From April to June 2017, in‐depth interviews were conducted with young adults aged 18 to 27 years living with HIV in order to capture the spectrum of experiences from pre‐transitioning youth to those who successfully transitioned to adult care. Young adults were purposively recruited based on prior study enrollees and recommendations from healthcare staff. Recruitment occurred in the adolescent, adult HIV and the prevention of mother to child transition clinics at Kilimanjaro Christian Medical Centre. Two separate in‐depth interviews were conducted with eligible participants. Medical records were reviewed retrospectively to collect information on HIV‐related outcomes. Results In‐depth interviews were held with 19 young adults. Participants mean age was 23.8 years (interquartile range 22.2 to 26.3 years); 53% were female. Most (78.9%) participants had been receiving anti‐retroviral therapy for nearly a decade and 72.2% were virologically suppressed (HIV RNA <200 copies/mL). Barriers to transition included fear of losing peer networks formed in the adolescent clinic, the abrupt manner in which young adults were asked to transition, stigma, financial constraints and a lower quality of care in the adult clinic. Facilitators of transition included family and social support, positive perspectives on living with HIV and maintenance of good health. Recommendations for transition included transition preparation, transition as a group and adoption of desirable aspects of the adolescent clinic (peer networks and education) in the adult clinic. Conclusions Transition is a complex process influenced by many factors. As the number of young adults living with HIV continues to grow, it is vital to develop a transition protocol that addresses these challenges and is feasible to implement in low‐resource settings.

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“…Although fewer children are becoming infected as prevention of mother-to-child transmission programs are scaled up, those who are perinatally infected and receiving antiretroviral therapy (ART) are living longer. 1 , 2 The total annual number of children and adolescents living with HIV is therefore a function of the decreasing number of perinatal infections, longer survival into adolescence, and aging up out of adolescence into adult care of previously perinatally infected children. Such factors related to the timing of infection and transition from pediatric into adult-focused HIV care impact how pediatric HIV clinical and program data are interpreted, and require different analytical methods from those used to study adult observational cohorts (eg, disaggregation by age and mode of infection; tracking patients as they transition).…”

Section: Introductionmentioning

confidence: 99%

Using Observational Data to Inform HIV Policy Change for Children and Youth

Sohn¹,

Judd

Mofenson

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Abstract:Observational data characterizing the pediatric and adolescent HIV epidemics in real-world settings are critical to informing clinical guidelines, governmental HIV programs, and donor prioritization. Global expertise in curating and analyzing these data has been expanding, with increasingly robust collaborations and the identification of gaps in existing surveillance capacity. In this commentary, we describe existing sources of observational data for children and youth living with HIV, focusing on larger regional and global research cohorts, and targeted surveillance studies and programs. Observational data are valuable resources to cross-validate other research and to monitor the impact of changing HIV program policies. Observational studies were among the first to highlight the growing population of children surviving perinatal HIV and transitioning to adolescence and young adulthood, and have raised serious concerns about high rates of treatment failure, loss to follow-up, and death among older perinatally infected youth. The use of observational data to inform modeling of the current global epidemic, predict future patterns of the youth cascade, and facilitate antiretroviral forecasting are critical priorities and key end products of observational HIV research. Greater investments into data infrastructure are needed at the local level to improve data quality and at the global level to faciliate reliable interpretation of the evolving patterns of the pediatric and youth epidemics. Although this includes harmonized data forms, use of unique patient identifiers to allow for data linkages across routine data sets and electronic medical record systems, and competent data managers and analysts are essential to make optimal use of the data collected.

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

Cited by 15 publications

References 14 publications

Pediatric to adult healthcare transitioning for adolescents living with HIV in Nigeria: A national survey

Pediatric to adult healthcare transitioning for adolescents living with HIV in Nigeria: A national survey

Challenges and facilitators of transition from adolescent to adult HIV care among young adults living with HIV in Moshi, Tanzania

Using Observational Data to Inform HIV Policy Change for Children and Youth

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