Managing the transition from paediatric to adult care for HIV, Kenya

Njuguna, Irene; Beima‐Sofie, Kristin; Mburu, Caren; Mugo, Cyrus; Black, Danae; Itindi, Janet; Onyango, Alvin; Slyker, Jennifer A.; Oyiengo, Laura; John‐Stewart, Grace; Wamalwa, Dalton

doi:10.2471/blt.19.232702

Cited by 20 publications

(22 citation statements)

References 31 publications

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“…There is also a recognized gap in the published evidence on rates of transfer from child-centered care (CCC) to adult-centered care (ACC) and on subsequent outcomes following transfer, especially in RLS [ 15 – 17 ]. Whereas transfer refers to the movement of a child from CCC to ACC on a particular date or movement of a patient from one facility to another, transition can be defined as the purposeful and planned process preceding and following the transfer event during which the adolescent is assessed for readiness, prepared for transfer with knowledge and skills, and followed up after transfer to ensure retention and effective self-management of their health [ 18 ]. Most LMIC, including Nigeria, lack national guidelines for transition of adolescents in HIV care, and there is great in-country heterogeneity in transitional care models that vary by program [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal evaluation of adherence, retention, and transition patterns of adolescents living with HIV in Nigeria

et al. 2020

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Introduction Adherence to antiretroviral therapy (ART) and retention in treatment programs are required for successful virologic suppression and treatment outcomes. As the number of adolescents living with HIV continues to increase globally, more information about adherence and retention patterns during and through transition from child- to adult-centered care is needed to ensure provision of a high level of care and inform development of targeted interventions to improve patient outcomes in this vulnerable population. In this analysis, we sought to describe long-term trends in adherence, retention, and virologic suppression in adolescents receiving ART at a pediatric HIV clinic in Nigeria through transition to the adult clinic. Setting The Jos University Teaching Hospital, United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded HIV clinic in Jos, Plateau State, Nigeria. Methods We conducted a retrospective observational longitudinal evaluation of data that had been collected during the course of care in a large pediatric ART program in Nigeria. We used descriptive statistics to define our patient population and quantify retention from ART initiation through adolescence and transition to adult-centered care. Logistic regression was used to evaluate predictors of loss to follow-up. We used medication possession ratio (MPR) to quantify adherence for each year a patient was on ART. To evaluate adherence and virologic suppression, we measured the proportion of patients with ≥95% MPR and the proportion with virologic suppression (viral load ≤400 copies/mL) within each age cohort, and used bivariate analyses to examine any association between MPR and VL suppression for all person-years observed. Results A total of 476 patients received at least one dose of ART as an adolescent (ages 10–19 years). The proportions of patients lost to follow-up were: 11.9% (71/597) prior to adolescence, 19.1% (31/162) during adolescence, and 13.7% (10/73) during transition to adult-centered care. While over 80% of patients had ≥95% medication adherence in all age groups, their viral load suppression rates through adolescence and post-transition were only 55.6%–64.0%. For patients that successfully transitioned to adult-centered care, we observed 87.7% (50/57) retention at month 12 post-transition, but only 34.6% (9/26) viral load suppression. Conclusions Our evaluation found considerable proportions of adolescents lost to follow-up throughout the ART program cascade. We also found discrepancies between the proportions of patients with ≥95% MPR and the proportions with VL suppression, suggesting that true medication adherence in this population may be poor. Significant attention and targeted interventions to improve retention and adherence focused on adolescents are needed in order for global programs to achieve 90-90-90 goals.

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Section: Introductionmentioning

confidence: 99%

Longitudinal evaluation of adherence, retention, and transition patterns of adolescents living with HIV in Nigeria

et al. 2020

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“…The Young Adolescent Programme Support (YAPS) Project which started in 2019 is attempting to empower adolescents and young people Transition is "a planned process by which HIV-infected adolescents and young adults, and their caregivers, are empowered with knowledge and skills to enable them to independently manage their health." [14]. The main goal of transitional care is for YPLHIV to develop con dence, autonomy, and responsibility for their HIV care by the time they are required to attend adult clinics.…”

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

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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 is "a planned process by which HIV-infected adolescents and young adults, and their caregivers, are empowered with knowledge and skills to enable them to independently manage their health." (11). The main goal of transitional care is for young people living with HIV infection (YPLHIV) is to nurture con dence, autonomy, and responsibility for their HIV care by the time they are required to attend adult clinics.…”

Section: Adolescent Transition Successful Outcomes Have Been Reportedmentioning

confidence: 99%

Ethical challenges of the healthcare transition to adult Antiretroviral therapy (ART) clinics for HIV infected adolescents and young people in Uganda

Mbalinda¹,

Bakeera-Kitaka²,

Amooti³

et al. 2020

Preprint

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Introduction Many HIV infected adolescents require transfer of care from paediatric/ adolescent clinics to adult ART clinics. Transition is beset with factors that hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a successful transition. The purpose of this study was to analyse the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics. Method We conducted 18 focus group discussions among 191 adolescents attending 9 different health facilities in Uganda. We explored facilitators and barriers regarding adolescent transitioning to adult HIV clinics. Thematic data analysis was used to analyze the data. The Silences Framework guided the data analysis and interpretation. The principles of Bioethics and the four-boxes ethics framework for clinical care (Patient autonomy, Medical indications, Context of care and Quality of life) were used to analyze the ethical issues surrounding the transition to adult HIV care. Results The key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of both privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort; and contextual factors are critical to successful transition. Conclusion The priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition to ensure retention in HIV care, facilitate long-term self-care, provide ongoing holistic healthcare and support in order to promote health and wellbeing, and build trust in the healthcare system. Identifying what facilitates successful transitions, and the gaps that interventions can target, may ensure HIV-infected youth remain healthy across the healthcare transition.

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Managing the transition from paediatric to adult care for HIV, Kenya

Cited by 20 publications

References 31 publications

Longitudinal evaluation of adherence, retention, and transition patterns of adolescents living with HIV in Nigeria

Longitudinal evaluation of adherence, retention, and transition patterns of adolescents living with HIV in Nigeria

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

Ethical challenges of the healthcare transition to adult Antiretroviral therapy (ART) clinics for HIV infected adolescents and young people in Uganda

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