Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study

Hussen, Sophia A.; Chakraborty, Rana; Knežević, Andrea; Camacho-González, Andrés; Huang, Eugene; Stephenson, Robert; Rı́o, Carlos del

doi:10.7448/ias.20.1.21848

Cited by 34 publications

(50 citation statements)

References 21 publications

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“…Nevertheless, a study conducted at Zomba Central Hospital in Malawi showed that the odds of attrition were 3.7-times lower in ALHIV exposed to Teen Clubs than those who were not exposed [17]. This was consistent with studies conducted in high income countries [10,12,19,20] South Africa [18]. However, the Malawian and South African studies did not explore the clinical outcomes of these adolescents and did not identify the speci c elements of the teen clubs which were critical in ensuring successful transitioning.…”

Section: Introductionsupporting

confidence: 75%

An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE‐AIM Framework.

Galagade¹,

Mwapasa²

2020

Preprint

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Background: High attrition is a major problem for Adolescent Living with HIV (ALHIV) transitioning from pediatric to adult care. Although the HIV Teen Club model has been shown to promote antiretroviral (ARV) adherence and viral suppression among ALHIV, its effect on promoting transitioning ALHIV from pediatric to adult care has not been formally evaluated. We sought to estimate the proportion of ALHIV enrolled in HIV Teen Clubs who successfully transitioned to adult care within six months of the expected transition time and assess health facilities’ fidelity in implementing HIV Teen Clubs’ adult care transition protocols and factors associated with successful transition to adult Care. Methods: From September 2018 to June 2019, we conducted a retrospective cohort study involving ALHIV attending HIV Teen Clubs in 14 primary health facilities in Blantyre, Malawi who had reached the recommended transition age of 18/19 years between July - December 2017. After obtaining consent, we reviewed their records to assess the proportion who successfully transitioned and also factors associated with transitioning. Checklist was used to ascertain fidelity of implementation of HIV Teen Club transition protocols. In-depth interviews were conducted with service providers (SP) in health facilities providing HIV Teen Club to get their perspectives on reasons for successful or unsuccessful transition.Results: Of the 131 eligible ALHIV enrolled in the study, only 6.9% (n=9) successfully transitioned to adult care within six months of the expected transition time. The overall fidelity in implementing adult care transition protocols in health facilities was medium. There was an association between implementation fidelity and ALHIV successful transition with 2 out of 3 health facilities with high implementation fidelity also successfully transitioning ALHIV into adult care. Successful ALHIV transitioning was associated with urban location of health facilities and ownership of the facilities by NGOs. SPs reported that lack of training in transitioning ALHIV, lack of clear guidelines, inadequate human resource and refusal of ALHIV to transition were some of the health system factors negatively influencing successful transition. Conclusions: Training and mentorship of SP in implementing transitioning protocols and adequately resourcing HIV teen clubs may improve their operations and facilitate successful transitioning.

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Section: Introductionsupporting

confidence: 75%

An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE‐AIM Framework.

Galagade¹,

Mwapasa²

2020

Preprint

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“…IeDEA-SA Steering Group: Frank Tanser, Africa Centre for Health and Population Studies, University of Kwazulu-Natal, Somkhele, South Africa; Christopher Hoffmann, Aurum Institute for Health Research, Johannesburg, South Africa; Michael Vinikoor, Centre for Infectious Disease Research in Zambia, Lusaka, Table 5. Regression of predictors of retention in the 12 months after the age of transition across transition-age thresholds: 16,18,20…”

Section: A C K N O W L E D G E M E N T Smentioning

confidence: 99%

Characterizing the double‐sided cascade of care for adolescents living with HIV transitioning to adulthood across Southern Africa

Tsondai

Sohn²,

Phiri

et al. 2020

J Intern AIDS Soc

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Introduction As adolescents and young people living with HIV (AYLH) age, they face a “transition cascade,” a series of steps associated with transitions in their care as they become responsible for their own healthcare. In high‐income countries, this usually includes transfer from predominantly paediatric/adolescent to adult clinics. In sub‐Saharan Africa, paediatric HIV care is mostly provided in decentralized, non‐specialist primary care clinics, where “transition” may not necessarily include transfer of care but entails becoming more autonomous for one's HIV care. Using different age thresholds as proxies for when “transition” to autonomy might occur, we evaluated pre‐ and post‐transition outcomes among AYLH. Methods We included AYLH aged <16 years at enrolment, receiving antiretroviral therapy (ART) within International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA‐SA) sites (2004 to 2017) with no history of transferring care. Using the ages of 16, 18, 20 and 22 years as proxies for “transition to autonomy,” we compared the outcomes: no gap in care (≥2 clinic visits) and viral suppression (HIV‐RNA <400 copies/mL) in the 12 months before and after each age threshold. Using log‐binomial regression, we examined factors associated with no gap in care (retention) in the 12 months post‐transition. Results A total of 5516 AYLH from 16 sites were included at “transition” age 16 (transition‐16y), 3864 at 18 (transition‐18y), 1463 at 20 (transition‐20y) and 440 at 22 years (transition‐22y). At transition‐18y, in the 12 months pre‐ and post‐transition, 83% versus 74% of AYLH had no gap in care (difference 9.3 (95% confidence interval (CI) 7.8 to 10.9)); while 65% versus 62% were virally suppressed (difference 2.7 (−1.0 to 6.5%)). The strongest predictor of being retained post‐transition was having no gap in the preceding year, across all transition age thresholds (transition‐16y: adjusted risk ratio (aRR) 1.72; 95% CI (1.60 to 1.86); transition‐18y: aRR 1.76 (1.61 to 1.92); transition‐20y: aRR 1.75 (1.53 to 2.01); transition‐22y: aRR 1.47; (1.21 to 1.78)). Conclusions AYLH with gaps in care need targeted support to prevent non‐retention as they take on greater responsibility for their healthcare. Interventions to increase virologic suppression rates are necessary for all AYLH ageing to adulthood.

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“…13 Hussen and colleagues 10 suggested that patient attendance at a first visit, or even a second visit, does not necessarily suggest long-term engagement, because only 50-89% of young people with HIV who successfully transition were retained in adult care after 1 year, and even fewer (56%) after 2 years. 17,48 This poor retention suggests transfer is an important but insufficient piece of health-care transition-akin to care linkage after a positive HIV test result being crucial to, yet unique from, care engagement. 49 The development of a system such as a patient registry, like the one available in some European countries, 28,29,50,51 would allow young people with HIV to be clinically followed up, and the completion and outcome of the health-care transition process documented.…”

Section: Evaluation Of Health-care Transitionmentioning

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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Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study

Cited by 34 publications

References 21 publications

An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE‐AIM Framework.

An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE‐AIM Framework.

Characterizing the double‐sided cascade of care for adolescents living with HIV transitioning to adulthood across Southern Africa

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

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