Barriers and Facilitators to the Successful Transition of Adolescents Living with HIV from Pediatric to Adult Care in Low and Middle-Income Countries: A Systematic Review and Policy Analysis

Jones, Cameron; Ritchwood, Tiarney D.; Taggart, Tamara

doi:10.1007/s10461-019-02621-6

Cited by 31 publications

(19 citation statements)

References 21 publications

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“…The details of our search strategy have been previously recorded [ 26 ]. In summary, we followed Lipsey and Wilson’s (2001) suggestions on conducting systematic reviews [ 27 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

et al. 2020

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Background: Adolescents living with HIV (ALWH) who transition from pediatric to adult care face several challenges that increase their risk of experiencing treatment interruptions and being lost to HIV care with resultant increased morbidity and mortality. To date, few studies have examined their outcomes post-healthcare transition (HCT), precluding the development and dissemination of evidence-based interventions aimed at retaining ALWH in HIV care both during and after HCT. We conducted a systematic review to synthesize the outcomes of ALWH post-HCT to provide suggestions for future directions. Methods: We systematically searched several electronic databases through October 2019 using keywords for HIV, HCT and ALWH. We categorized studies by target population, country (i.e., upper-high income and low-middle income), study design (i.e., descriptive, mixed methods, quantitative), outcomes measured, and follow-up period. Results: A total of 24 studies met inclusion criteria. Studies were categorized according to the following HCT outcomes: retention in HIV care post-HCT (n = 13), changes in CD4+ count and viral load post-HCT (n = 16), and mortality among ALWH post-HCT (n = 7). Most studies (n = 11) examining retention in HIV care indicated that more than 70% of ALWH were retained in care 1-2 years post-HCT while the remaining studies (n = 2) reported retention rates less than 55%. While studies indicated that CD4+ counts and viral loads tended to worsen during the first few years post-HCT, these differences were often not statistically significant. Among all ALWH who transitioned to adult care, a small proportion died within their first seven years post-HCT. Among qualitative studies, common themes included transition readiness (n = 6), provider-patient relationship in the adult clinic setting (n = 6), and concern about the adult clinic setting (n = 4). Conclusions: Transition outcomes were poorest for ALWH with unsuppressed viremia pre-HCT, suggesting that this subgroup of ALWH may need greater support from their treatment teams and caregivers during and post-HCT to improve clinical outcomes.

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“…The details of our search strategy have been previously recorded [ 26 ]. In summary, we followed Lipsey and Wilson’s (2001) suggestions on conducting systematic reviews [ 27 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

et al. 2020

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“…9 Important insights were discovered regarding the barriers and facilitators associated with successful implementation in more resourcelimited contexts, but with substantial variation across country-specific guidelines. 10 In a recent systematic review summarising literature related to HCT for adolescents living with HIV in LMICs, Jones et al concluded that surveillance systems to monitor and evaluate needs during transition, incorporation of caregiver and adult treatment team training, and development of specific HCT guidelines may better facilitate successful transition for adolescents living with HIV. 10 Given the inequity that often exists across other less-funded disease burdens, the purpose of this study was to review available literature on paediatric to adult transition and age-appropriate care of adolescents with paediatric-onset disease in the absence of a diagnosis of HIV and in limited resource settings, in order to inform strategies for transition across varied resource settings.…”

Section: What This Study Adds?mentioning

confidence: 99%

“…In a large systematic review for HCT in adolescents with HIV in LMICs, promising programmes were found to be patient-centred, to encourage early discussions about HCT for adolescents living with HIV and to maintain flexibility to delay transition if the necessary skills to manage care had not yet been developed. 10 Access to healthcare and health system reforms must be addressed in order to provide equitable transition In resource-rich settings such as the USA, six core elements, as outlined by gotransition. org, 25 have largely set the foundation for HCT through quality improvement methodology.…”

Section: Clinical Milestonesmentioning

confidence: 99%

Paediatric to adult healthcare transition in resource-limited settings: a narrative review

Narla

Ratner

Bastos

et al. 2021

bmjpo

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BackgroundAgeing into adulthood is challenging at baseline, and doing so with a chronic disease can add increased stress and vulnerability. Worldwide, a substantial care gap exists as children transition from care in a paediatric to adult setting. There is no current consensus on safe and equitable healthcare transition (HCT) for patients with chronic disease in resource-denied settings. Much of the existing literature is specific to HIV care. The objective of this narrative review was to summarise current literature related to adolescent HCT not associated with HIV, in low-income and middle-income countries (LMICs) and other resource-denied settings, in order to inform equitable health policy strategies.MethodsA literature search was performed using defined search terms in PubMed and Cumulative Index to Nursing and Allied Health Literature databases to identify all peer-reviewed studies published until January 2020, pertaining to paediatric to adult HCT for adolescents and young adults with chronic disease in resource-denied settings. Following deduplication, 1111 studies were screened and reviewed by two independent reviewers, of which 10 studies met the inclusion criteria. Resulting studies were included in thematic analysis and narrative synthesis.ResultsTwelve subthemes emerged, leading to recommendations which support equitable and age-appropriate adolescent care. Recommendations include (1) improvement of community health education and resilience tools for puberty, reproductive health and mental health comorbidities; (2) strengthening of health systems to create individualised adolescent-responsive policy; (3) incorporation of social and financial resources in the healthcare setting; and (4) formalisation of institution-wide procedures to address community-identified barriers to successful transition.ConclusionLimitations of existing evidence relate to the paucity of formal policy for paediatric to adult transition in LMICs for patients with childhood-onset conditions, in the absence of a diagnosis of HIV. With a rise in successful treatments for paediatric-onset chronic disease, adolescent health and transition programmes are needed to guide effective health policy and risk reduction for adolescents in resource-denied settings.

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“…The HIV care continuum emphasizes maintaining the health of PLHIV and preventing transmission through adherence to treatment [10,11]. Systematic reviews of the barriers and facilitators of the HIV care continuum, reported in the previous studies, were limited to patients with HIV in speci c populations [12,13], or only included a speci ed time point of the HIV care continuum [14]. Additionally, in a systematic review, there is a limitation in that neither quantitative nor qualitative studies are comprehensively analyzed and integrated [15].…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators on the HIV Care Continuum: a Scoping Review Protocol

Kim¹,

Kim²,

Park³

et al. 2021

Preprint

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Background: As the life expectancy of people living with HIV (PLHIV) increases with the advancements in antiretroviral treatment, the continuity of long-term therapy and health care for PLHIV has gained more importance. However, the estimated proportion of PLHIV who have access to treatment or who are virally suppressed is unsatisfactory. Therefore, it is necessary to build strategies to improve treatment continuity by identifying the barriers and facilitators that affect the HIV care continuum. To enable this, we will conduct a scoping review to explore the barriers and facilitators on the care continuum for PLHIV.Methods: Based on the scoping review framework, the research questions will identify the factors affecting the care continuum of PLHIV, supported by a literature search we will conduct on the databases of MEDLINE, EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Cochrane library. Additionally, we will review guidelines and policies on HIV care published by organizations related to HIV infection to ascertain the barriers and facilitators in the continuity of care. Four researchers will screen articles for inclusion and subsequently build a charting form and collate the data to provide results.Discussion: The results of this scoping review will provide comprehensive evidence for influencing factors to be considered in the care continuum of PLHIV. Importantly, the results will provide insight for health care providers and researchers to develop interventions and research the continuity in caring for PLHIV.

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Barriers and Facilitators to the Successful Transition of Adolescents Living with HIV from Pediatric to Adult Care in Low and Middle-Income Countries: A Systematic Review and Policy Analysis

Cited by 31 publications

References 21 publications

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

Paediatric to adult healthcare transition in resource-limited settings: a narrative review

Barriers and Facilitators on the HIV Care Continuum: a Scoping Review Protocol

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