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

Abstract

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.

Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda

“…In a study in United Kingdom, among young adults with perinatally acquired HIV infection that assessed the clinical outcomes post transition to adult services, 86% of these youths were retained in HIV care [ 27 ]. In a systematic review by Ritchwood et al [ 28 ] to examine retention in HIV care, it indicated that more than 70% of such adolescents who were infected with HIV perinatally were retained in care 1–2 years post-Health Care Transition. Such youths are better retained in care because of the special attention they receive during their paediatric HIV care, and the intense preparations for transitions into adult care [ 29 ].…”

“…These adolescents and young adults have been found to have a special patient-provider relationship that is constituted by a strong bond in between since the provider understands the patient in details [ 29 ]. There is an element of adaptation to the clinic environment, boosted by the individual experience [ 28 ].…”

Are we there yet? 40 years of successes and challenges for children and adolescents living with HIV

“…While CAWH‐focused HIV services may offer individualized behavioural and social support, transitioning into adult care often negatively affects older youth as they “age out” of more child‐friendly paediatric health systems into larger clinics that lack such support services. This transition period can be a time of increased risks of poor adherence and viral outcomes [8].…”

Community-Based Accompaniment for Adolescents Transitioning to Adult HIV Care in Urban Peru: a Pilot Study

“…A key strength of the intervention was its comprehensive nature (i.e., it was designed to address a broad spectrum of unmet social and health needs) and individualized design (i.e., it sought to respond to each adolescent's needs, tailoring the intensity of support offered to each participant). Research has highlighted the limited efficacy of a "one size fits all" approach for community-based interventions [8,44,45], in part because subgroups at highest risk may need extra support [46,47]. In this intervention, entry-level health workers filled gaps in care, provided linkages, liaised with providers, and literally accompanied adolescents as they transitioned to adult care.…”