Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the “Movin’ Out” Transitioning Protocol

Maturo, Donna; Powell, Alexis; Major-Wilson, Hannah; Sanchez, Kenia; Santis, Joseph P. De; Friedman, Lawrence B.

doi:10.1016/j.pedn.2015.06.013

Cited by 40 publications

(53 citation statements)

References 18 publications

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“…Challenges include how to support these youth as they transition from paediatric HIV services to adult HIV care settings, ensuring they keep appointments, continue to adhere to life-saving medications, and maintain their health, as they assume a greater, more independent role in their healthcare. Research and manuals describing interventions to promote self-care and ART adherence, increase youth self-esteem, promote family planning, and reduce sexual risk behaviours among youth transitioning from paediatric to adult HIV care services have been published, but mainly from resource-rich settings [1,[5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The Happy Teen programme: a holistic outpatient clinic‐based approach to prepare HIV‐infected youth for the transition from paediatric to adult medical care services in Thailand

Lolekha

Boon-yasidhi

Na-Nakorn

et al. 2017

Journal of the International AIDS Society

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Introduction: We developed an 18‐month Happy Teen 2 (HT2) programme comprised of a one‐day workshop, two half‐day sessions, and three individual sessions to prepare HIV‐infected youth for the transition from paediatric to adult HIV care services. We describe the programme and evaluate the change in youth's knowledge scores.Methods: We implemented the HT2 programme among HIV‐infected Thai youth aged 14–22 years who were aware of their HIV status and receiving care at two hospitals in Bangkok (Siriraj Hospital, Queen Sirikit National Institute of Child Health [QSNICH]). Staff interviewed youth using a standardized questionnaire to assess HIV and health‐related knowledge at baseline and at 12 and 18 months while they participated in the programme. We examined factors associated with a composite knowledge score ≥95% at month 18 using logistic regression.Results: During March 2014–July 2016, 192 of 245 (78%) eligible youth were interviewed at baseline. Of these, 161 (84%) returned for interviews at 12 and 18 months. Among the 161 youth, the median age was 17 years, 74 (46%) were female, and 99% were receiving antiretroviral treatment. The median composite score was 45% at baseline and increased to 82% at 12 months and 95% at 18 months (P < 0.001). The range of median knowledge scores for antiretroviral management, HIV monitoring, HIV services, and family planning significantly increased from baseline (range 0–75%) to (range 67–100%) at 12 months and to 100% at 18 months (P < 0.001). Almost all youth were able to describe education and career goals at 12 and 18 months compared to 75% at baseline. In multivariable analysis, a composite knowledge score at 18 months >95% was associated with education level >high school (aOR: 2.15, 95%CI, 1.03–4.48) and receipt care at QSNICH (aOR: 2.43, 95%CI, 1.18–4.98). Youth whose mother and father had died were less likely to have score ≥95% (aOR: 0.22, 95%CI, 0.07–0.67) than those with living parents.Conclusions: Knowledge useful for a successful transition from paediatric to adult HIV care increased among youth participating in the HT2 programme. Youth follow‐up will continue to assess the impact of improved knowledge on outcomes following the transition to adult care services.

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Section: Introductionmentioning

confidence: 99%

The Happy Teen programme: a holistic outpatient clinic‐based approach to prepare HIV‐infected youth for the transition from paediatric to adult medical care services in Thailand

Lolekha

Boon-yasidhi

Na-Nakorn

et al. 2017

Journal of the International AIDS Society

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“…9 Although these studies found positive short-term health outcomes (better glycosylated haemoglobin (Hb1Ac) levels and less short-term complications) and follow-up rates, there is currently no evidence for (long-term) outcomes of TCs with regard to health outcomes, healthcare use, self-management and psychosocial functioning of young adults. Moreover, recent studies of TCs in other diagnostic groups did not include a controlled pre-post outcome evaluation, [19][20][21][22][23][24][25][26][27][28][29][30] and as such could not provide sound evidence on outcomes of TCs. In general, there is inconclusive evidence considering the effectiveness of transitional care.…”

Section: Introductionmentioning

confidence: 99%

Evaluating outpatient transition clinics: a mixed-methods study protocol

et al. 2016

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IntroductionTo support young people in their transition to adulthood and transfer to adult care, a number of interventions have been developed. One particularly important intervention is the transition clinic (TC), where paediatric and adult providers collaborate. TCs are often advocated as best practices in transition care for young people with chronic conditions, but little is known about TC models and effects. The proposed study aims to gain insight into the added value of a TC compared with usual care (without a TC).Methods and analysisWe propose a mixed-methods study with a retrospective controlled design consisting of semistructured interviews among healthcare professionals, observations of consultations with young people, chart reviews of young people transferred 2–4 years prior to data collection and questionnaires among the young people included in the chart reviews. Qualitative data will be analysed through thematic analysis and results will provide insights into structures and daily routines of TCs, and experienced barriers and facilitators in transitional care. Quantitatively, within-group differences on clinical outcomes and healthcare use will be studied over the four measurement moments. Subsequently, comparisons will be made between intervention and control groups on all outcomes at all measurement moments. Primary outcomes are ‘no-show after transfer’ (process outcome) and ‘experiences and satisfaction with the transfer’ (patient-reported outcome). Secondary outcomes consider clinical outcomes, healthcare usage, self-management outcomes and perceived quality of care.EthicsThe Medical Ethical Committee of the Erasmus Medical Centre approved the study protocol (MEC-2014-246).DisseminationStudy results will be disseminated through peer-reviewed journals and conferences. The study started in September 2014 and will continue until December 2016. The same study design will be used in a national study in 20 diabetes settings (2016–2018).

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“…There are multiple challenges that impede implementation. A key barrier is the nature of existing transition guidance and programmatic protocols [21,22] which tend to emanate from the United States. Typically, a highly client-centred approach, driven by clinicians and tailored to the individual adolescent is advised [21,23,24].…”

Section: Discussionmentioning

confidence: 99%

What is it going to take to move youth‐related HIV programme policies into practice in Africa?

Mark¹,

Taing²,

Cluver

et al. 2017

Journal of the International AIDS Society

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Introduction: HIV has been reported to be the leading cause of mortality amongst adolescents in Africa. This has brought attention to the changes in service provision and health management that many adolescents living with HIV experience when transferring from specialized paediatric- or adolescent-focused services to adult care. When transition is enacted poorly, adherence may be affected and the continuum of care disrupted. As the population of HIV-infected adolescents grows, effective and supported transition increases in significance as an operational imperative.Discussion: Considerable gaps remain in moving policy to practice at global, national, and local levels. Policies that give clear definition to transition and provide standard operating procedures or tools to support this process are lacking. National guidelines tend to neglect transition. Beyond transition itself, there has been slow progress on the inclusion of adolescents in national policies and strategies. Guidance often overlooks the specific needs and rights of adolescents, in particular for those living with HIV. In some cases, prohibitive laws can impede adolescent access by applying age of consent restriction to HIV testing, counselling and treatment, as well as SRH services. Where adolescent-focused policies do exist, they have been slow to emerge as tangible operating procedures at health facility level. A key barrier is the nature of existing transition guidance, which tends to recommend an individualized, client-centred approach, driven by clinicians. In low- and middle-income settings, flexible responses are resource intensive and time consuming, and therefore challenging to implement amidst staff shortages and administrative challenges. First, national governments must adopt transition-specific policies to ensure that adolescents seamlessly receive appropriate and supportive care. Second, transition policies must form part of a broader adolescent-centred policy landscape and adolescent-friendly orientation and approach at health system level. Third, national actors must ensure that transition policies are supported at implementation level. Fourth, youth involvement and community mobilization are essential. Finally, further implementation research is urgently needed to better understand how to support young people and providers in achieving smooth transitions.Conclusions: Only by moving from policy to practice through supportive policies and their implementation will we be closer to including adolescents in the 2030 goal of ending AIDS.

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Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the “Movin’ Out” Transitioning Protocol

Cited by 40 publications

References 18 publications

The Happy Teen programme: a holistic outpatient clinic‐based approach to prepare HIV‐infected youth for the transition from paediatric to adult medical care services in Thailand

The Happy Teen programme: a holistic outpatient clinic‐based approach to prepare HIV‐infected youth for the transition from paediatric to adult medical care services in Thailand

Evaluating outpatient transition clinics: a mixed-methods study protocol

What is it going to take to move youth‐related HIV programme policies into practice in Africa?

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