Transition of Youth Living with HIV from Pediatric to Adult-Oriented Healthcare: A Review of the Literature

Hussen, Sophia A.; Chahroudi, Ann; Boylan, Ashley; Camacho-González, Andrés; Hackett, Stephanie; Chakraborty, Rana

doi:10.2217/fvl.14.73

Cited by 62 publications

(51 citation statements)

References 26 publications

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“…The aim is to promote youth self‐confidence, improve the communication skills of youth and their caretakers, and to allow youth to share experiences and receive support from their peers and caretakers for issues related to sexual reproductive health, career plans, and HIV care [10]. The programme engaged adult providers to participate in the one‐day workshop and half‐day meetings so that adult providers and youth could work together to coordinate the transition from one provider to another [1,2,21,22]. In Thailand, many youth live with their parents or relatives and are under the direct supervision of adult caretakers.…”

Section: Resultsmentioning

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: Resultsmentioning

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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“…Approximately 25,000 HIV-infected youth are scheduled to transition in the next decade 10 , demonstrating the need for effective transition approaches to support care engagement and continued treatment in adult HIV care settings. Initially successful transitions do not necessary suggest long-term engagement 11 : only 50% of youth who successfully transition were retained in adult care after one year 12 .…”

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confidence: 99%

Adolescent to Adult HIV Health Care Transition From the Perspective of Adult Providers in the United States

Tanner

Philbin

et al. 2017

Journal of Adolescent Health

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Purpose The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during healthcare transition from adolescent- to adult-centered HIV care. HIV-related healthcare transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers’ perspectives. Methods We examined healthcare transition processes through semi-structured interviews with 28 adult clinic staff across Adolescent Trials Network (ATN) sites. We also collected quantitative data related to clinical characteristics and transition-specific strategies. Results Overall, participants described healthcare transition as a “warm handoff” and a collaborative effort across adolescent and adult clinics. Emergent transition themes included: adult clinical care culture (e.g., patient responsibility), strategies for connecting youth to adult care (e.g., adolescent clinic staff attending youth’s first appointment at adult clinic), and approaches to evaluating transition outcomes (e.g., data sharing). Participants provided transition improvement recommendations (e.g., formalized protocols). Conclusions Using evidence-based research and a quality improvement framework to inform comprehensive and streamlined transition protocols can help enhance the capacity of adult clinics to collaborate with adolescent clinics to provide coordinated and uninterrupted HIV-related care and improve continuum of care outcomes.

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“…The findings of a care system currently unsuitable for young is alarming since poorly adapted systems are recognized as barriers to optimal engagement in the care of patients with HIV [16]. Conversely, communication between adolescent and adult providers, and age- and developmentally-appropriate care, are considered key facilitators of successful healthcare transition [17].…”

Section: Introductionmentioning

confidence: 99%

Professional’s Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting

et al. 2017

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BackgroundIncreasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition.MethodsQualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted.ResultsAdult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams’ experience, a simplified categorization of these young people into four levels can be used: those “who have everything good”; those who have some deficiencies that must be addressed; those “who have everything bad”; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment.ConclusionsDespite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition model and that a dedicated structure for transition care is not appropriate for all young people.

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Transition of Youth Living with HIV from Pediatric to Adult-Oriented Healthcare: A Review of the Literature

Cited by 62 publications

References 26 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

Adolescent to Adult HIV Health Care Transition From the Perspective of Adult Providers in the United States

Professional’s Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting

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