Transition of Care for Youth with HIV

Acree, Mary Ellen

doi:10.3928/19382359-20170424-02

Cited by 22 publications

(23 citation statements)

References 26 publications

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“…Studies note that YLWH have higher rates of anxiety and depression when compared to non-HIV-infected counterparts [32,34,35]. Mental health interventions that equip YLWH with coping and stress-relieving mechanisms may be effective in promoting a positive perspective on living with HIV, which is linked to good ART adherence and improved self-care [6,14,20,32]. This interplay of mental health issues and health maintenance suggests a critical role for strategies that improve resilience for YLWH in facilitating transition of care [20,32,[36][37][38].…”

Section: Individual Domainmentioning

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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Section: Individual Domainmentioning

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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“…Many individual and clinic-level barriers to health-care transition exist including poor health literacy, few life skills (including issues related to sexuality), insufficient health-care selfmanagement skills (including adherence), stigma, drug use and mental health issues, attachment to paediatric providers and fear of transitioning to adult clinics. 7,12,13,23,25,26,[31][32][33]35 For young people infected with HIV perinatally, the spectre of multidrug resistance complicates the already difficult health-care transition process. [28][29][30] However, addressing these barriers is possible through strategies including initiation of the health-care transition preparation process at an early age, with frequent reinforcement; addressing behavioural, emotional, and mental health problems in an ongoing fashion; providing education for all stakeholders; and anticipation of and proactive handling of challenges (figure 2).…”

Section: Recommendations and Next Stepsmentioning

confidence: 99%

“…6 The transition of young people with HIV from adolescent to adult services has become the focus of many studies and resultant reviews over the past 6 years. [7][8][9][10][11][12] Health-care transition is the purposeful movement of young people (18-25 years old) from childcentred to adult-centred care, 13 and successful transition is defined as young people having a non-paediatric provider, insurance, a recent health-care visit, and no treatment delay. 14 Transition to adult care is especially crucial for young people with HIV to remain healthy, maintain an undetectable viral load, and reduce secondary transmission.…”

Section: Introductionmentioning

confidence: 99%

Health-care transition from adolescent to adult services for young people with HIV

Straub

Tanner

2018

The Lancet Child & Adolescent Health

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HIV-related care and treatment engagement are crucial steps to improve individual and population-level health; yet, many young people (18-25 years old) with HIV are not maintained in, or disengage from, care. Health-care transition and the transfer to adult care are particularly vulnerable points in the care and treatment of young people with HIV. In this Review, we explore barriers and facilitators to health-care transition, evaluate existing health-care transition programmes, and identify best practices for the improvement of health-care transition outcomes and health. Although we examine health-care transition across a range of geographical regions, most examples are from the settings in which the most research has been done-the USA and western Europe.

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“…Perinatally or behaviorally HIV-infected adolescents (10-19 years) and young adults (20-24 years) are an increasing proportion of the HIV-infected population in Uganda [1], with over 110,000 HIV-infected adolescents in Uganda in 2012. There is a growing number of adolescents and young adults with HIV who require transfer of care from pediatric to adult providers [2]; yet, globally, many young people experience barriers (e.g., infrastructure, staff training) that complicate this process. Attention to this transition is critical to ensure continuity of complex care and can help mitigate potential adverse physical and psychological complications resulting from their HIV-infection or use of long-term medication therapies.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: Unintended consequences of successful adolescent ART clinics

Mbalinda

Bakeera-Kitaka

Amooti

et al. 2020

Preprint

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BackgroundThere is a growing number of adolescents and young adults with HIV who require transfer of care from pediatric/ adolescent clinics to adult ART clinic. Currently, adolescents are largely in the care of pediatricians; but as they grow, they transition to adult HIV clinics. The purpose of this study was to explore the facilitators and barriers of transitioning among adolescents from adolescent clinics to adult ART clinics.MethodAn explorative qualitative approach was utilised for this study. Eighteen focus group discussions were held in nine health facility with (191) adolescents and young people in order to capture their experiences, barriers and facilitators regarding transitioning to adult clinics. The focus group discussions were audio recorded and transcribed. The Silences Framework using thematic approach guided the analysis.Results The key emerging issues were: Care provided in the adolescent clinics, Unfriendly adults, stigma and discrimination, Congestion and long waiting time, health providers in adult clinics were barriers to transitioning. Moving as a cohort, Transition preparation, care in clinics, positive living, support from the guardian and Young adolescent program Support (YAPS) could facilitate readiness and transitioning.ConclusionAdolescents and young people expressed fear to transition to adult clinics mainly because of the perceived better care provided in adolescent clinic, thus constituting a barrier to smooth transition A range of individual, social and health system and services-related factors hindered transitioning. Expectation of transitioning as a group, assurance of similar care as in the adolescent clinic, and guarantees of confidentiality, privacy and autonomy in decision-making for care were perceived as facilitators. There is need to strengthen implementation of age-appropriate care and individualized case management during care transition at all health facilities. Furthermore, the findings suggest the need to create supportive family, peer, and healthcare environments for adolescent transition.

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Transition of Care for Youth with HIV

Cited by 22 publications

References 26 publications

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

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

Health-care transition from adolescent to adult services for young people with HIV

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: Unintended consequences of successful adolescent ART clinics

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