Transitioning HIV-Positive Adolescents to Adult Care: Lessons Learned From Twelve Adolescent Medicine Clinics

Abstract

Purpose To maximize positive health outcomes for youth with HIV as they transition from youth to adult care, clinical staff need strategies and protocols to help youth maintain clinic engagement and medication adherence. Accordingly, this paper describe transition processes across twelve clinics within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) to provide lessons learned and inform the development of transition protocols to improve health outcomes as youth shift from adolescent to adult HIV care. Design and Methods During a large multi-method Care Initiative program evaluation, three annual visits were completed at each site from 2010–2012 and conducted 174 semi-structured interviews with clinical and program staff (Baseline n=64, Year 1 n=56, Year 2=54). Results The results underscore the value of adhering to recent American Academy of Pediatrics (AAP) transition recommendations, including: developing formal transition protocols, preparing youth for transition, facilitating youth’s connection to the adult clinic, and identifying necessary strategies for transition evaluation. Conclusions Transitioning youth with HIV involves targeting individual-, provider-, and system-level factors. Acknowledging and addressing key barriers is essential for developing streamlined, comprehensive, and context-specific transition protocols. Practice Implications Adolescent and adult clinic involvement in transition is essential to reduce service fragmentation, provide coordinated and continuous care, and support individual and community level health.

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

“…Our results suggest that adult and adolescent clinic involvement is essential to provide coordinated care during HIV-related healthcare transition. Overall, adult clinics perceived a passive healthcare transition role (with primary responsibility placed on the youth and adolescent clinics); however, adult clinics’ active engagement in supporting healthcare transition is crucial for successful transition outcomes 15,23 . 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.…”

“…Adult clinics are different from adolescent clinics (e.g., space and provider training), and thus have distinct barriers to healthcare transition 5 . For example, adult facilities are often intimidating spaces for youth as they are less ‘friendly’ than adolescent clinics 13,15 . Further, participants stated that adult providers lacked training and experience in treating youth and were more likely to work in HIV-specific clinics (e.g., adult infectious disease) 13,15 .…”

“…For example, adult facilities are often intimidating spaces for youth as they are less ‘friendly’ than adolescent clinics 13,15 . Further, participants stated that adult providers lacked training and experience in treating youth and were more likely to work in HIV-specific clinics (e.g., adult infectious disease) 13,15 . Although not all adult clinics were able to create a ‘youth friendly’ environment, the way that staff, including the front desk, approached youth who were transitioning was important.…”

“…Formal protocols and stronger inter-clinic relationships may also improve overall quality improvement efforts (e.g., formalized inter-clinic data sharing and communication strategies) necessary to evaluate healthcare transition outcomes 15,19 . Results suggest that adult clinic involvement in transition is crucial, and highlight the importance of cultivating inter-clinic connections to support transition and provide uninterrupted care 24 .…”

“…However, these guidelines and previous HIV-related transition research focus almost exclusively on adolescents and adolescent/young adult clinics 14–17 . The adult clinic perspective is missing, even though it plays an equally important role in healthcare transition 12,15,18 . Understanding adult providers’ attitudes and comfort in treating youth, who are often dealing with other challenges (e.g., developmental stage), is essential in order to ascertain preparation gaps and needs.…”