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Kakkar F, Van der Linden D, Valois S, Maurice F, Onnorouille M, Lapointe N, Soudeyns H, Lamarre V. Health outcomes and the transition experience of HIV-infected adolescents after transfer to adult care in Québec, Canada. BMC Pediatr 2016; 16:109. [PMID: 27457719 PMCID: PMC4960665 DOI: 10.1186/s12887-016-0644-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 07/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Little is known on outcomes after transition to adult care among adolescents with perinatal HIV infection. Though there is data from other chronic pediatric diseases suggesting increased morbidity and mortality following transfer to adult care, this has not well been studied among the first wave of survivors of perinatal HIV infection. The primary objective of this study was to determine outcomes after transition to adult care among a cohort of HIV-infected adolescents in Québec, Canada. Secondary objectives were to document participant experiences with the transition process, identify barriers to successful transition, and potential changes to improve the transition process. Methods Clinic records were reviewed to identify all perinatally-infected youth who transitioned from the Centre Maternel et Infantile sur le Sida pediatric HIV clinic (Montreal) at age 18 to an adult care provider between 1999 and 2012. Transitioned patients were contacted using last available patient or parental listed phone number on hospital record, internet based telephone directory, or social media. A standardized questionnaire was administered by telephone or in-person interview, and copies of current medical records obtained from treating physicians. Results Forty-five patients were transferred between 1999 and 2012, among whom 25 consented to the study, eight were lost to follow-up, eight refused participation, and four were deceased. Overall 76 % of patients remained engaged in care, defined by at least one physician visit within 6 months of the interview. Over 50 % reported difficulty with adherence to their current drug regimens. At one-year post-transfer, there was a decrease in the proportion of patients with CD4 count >500 cells/mm3 from 64 to 29 %, and a statistically significant decrease in absolute CD4 count (mean 370 vs 524 cells/mm3, p = 0.04.). The majority (92 %) of participants felt that 18 was too young an age to transfer to adult care, and provided suggestions for improving the transition process. Conclusions This group of perinatally-infected youth remained engaged in care after transition, however difficulties with adherence and assuming responsibility for their own care were identified as issues in their post-transition care. The high rate of mortality among them and the changes to their health status post-transition suggest that further work is necessary to document the health outcomes of this group in larger, more diverse cohort settings.
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Affiliation(s)
- Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada. .,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada. .,Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada.
| | - Dimitri Van der Linden
- Cliniques universitaires Saint-Luc, Maladies Infectieuses Pédiatriques, Service de Pédiatrie Générale, Bruxelles, Belgium
| | - Silvie Valois
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Francois Maurice
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Marion Onnorouille
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Normand Lapointe
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada.,Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Hugo Soudeyns
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada.,Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, Canada.,Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Valerie Lamarre
- Division of Infectious Diseases, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada.,Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
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Nyabigambo A, Muliira JK, Atuyambe L, Babikako HM, Kambugu A, Ndoleriire C. Determinants of utilization of a no-cost HIV transition clinic: a cross-sectional study of young adults living with HIV/AIDS. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:89-99. [PMID: 24966709 PMCID: PMC4043429 DOI: 10.2147/ahmt.s57950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is minimal research that has been conducted among young adults to understand the determinants of the utilization of human immunodeficiency virus (HIV) health services in this population. The purpose of this study was to explore the levels and determinants of HIV transition clinic (HTC) services utilization by young adults living with HIV/acquired immunodeficiency syndrome (YALHA). The study used a cross-sectional design and quantitative methods to collect data from a sample of 379 YALHA between the ages of 15–24 years who were registered clients of an HTC in Uganda. During data analysis, utilization was categorized into two levels: regular (kept all appointment visits) and irregular (missed one or more appointment visits) utilization. Univariable, bivariable, and multivariable logistic regression analyses were used to examine the determinants associated with HTC utilization. The HTC services that were most utilized by the YALHA were those based at the clinic and provided by professional health care providers and these were: clinical examination (96%); laboratory services (87.1%); and counseling (69.7%). The services that were least utilized were home visiting (5.8%) and peer support services (19.8%). Of the 379 YALHA, only 32.4% regularly utilized the HTC. Multivariable analysis showed that the main determinants of HTC utilization were CD4 count category of ≥251/μL (adjusted odds ratio [AOR] =0.58, 95% confidence interval [CI] =0.36–0.95); not being on antiretroviral therapy (AOR =0.27, 95% CI =0.15–0.47); and not receiving counseling services (AOR =0.47, 95% CI =0.27–0.83). Regular utilization of the HTC by YALHA was low and utilization seems to be influenced by HIV infection stage and HIV counseling services, but not sociodemographic factors or community factors.
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Affiliation(s)
- Agnes Nyabigambo
- School of Public Health, Makerere University, Kampala, Uganda ; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Lynn Atuyambe
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS 2014; 28:128-35. [PMID: 24601734 DOI: 10.1089/apc.2013.0345] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIV-infected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.
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Affiliation(s)
- Brian C. Zanoni
- The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Charlestown, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts
- Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Cervia JS. Easing the transition of HIV-infected adolescents to adult care. AIDS Patient Care STDS 2013; 27:692-6. [PMID: 24073595 DOI: 10.1089/apc.2013.0253] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The past two decades have witnessed dramatic reductions in HIV-related morbidity and mortality following the introduction of combination antiretroviral therapy (cART) for infants and children. Improved therapeutic outcomes have changed the face of the HIV epidemic and with it the needs of patients and families. Consequently, many perinatally- and behaviorally-infected adolescents are now transitioning to adult care. What follows is a brief review and commentary concerning original research, reviews, and clinical guidelines describing challenges and best practices in facilitating care transitions for HIV-infected youth to adult care. Over 25,000 HIV-infected US youth aged 13-24 years will require transition to adult care within the next decade. Transition planning must address issues of cognitive development and mental health, medication adherence, sexuality, reproductive, and gender identity, socioeconomic and health insurance status, stigma and disclosure, disrupted relationships with pediatric care providers, and communication. Clinical experience with HIV and other chronic illnesses supports a multidisciplinary, developmentally-sensitive approach to meeting the challenges inherent in care transition that begins early and is monitored with regular evaluation and revision. Specific clinical recommendations have been made by the U.S. Department of Health and Human Services and the New York State Department of Health AIDS Institute.
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Affiliation(s)
- Joseph S. Cervia
- Department of Medicine and Pediatrics, Hofstra-North Shore LIJ School of Medicine, Manhasset, New York
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Persson A, Newman C. When HIV-positive children grow up: a critical analysis of the transition literature in developed countries. QUALITATIVE HEALTH RESEARCH 2012; 22:656-667. [PMID: 22218268 DOI: 10.1177/1049732311431445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Young people with perinatally acquired HIV are routinely problematized in the research literature as inadequately equipped to manage transition to adolescent sexuality and adult clinical care without comprehensive interventions, partly because of challenges associated with adolescence itself, and partly because of neurocognitive and psychosocial dysfunctions commonly attributed to these children. However, little is actually known about this population, given their recent emergence in the HIV epidemic. Using critical discourse analysis, we argue that several problematic assumptions operate in this literature, hampering the objective of understanding these young people. Our analysis can contribute to a reframing of future research on HIV-positive adolescents, by encouraging greater attunement to the experiences of the adolescents themselves and to the discursive meanings that underpin research agendas, so that different and more productive questions can be asked and answered.
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Affiliation(s)
- Asha Persson
- University of New South Wales, Sydney, New South Wales, Australia
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Katz JD, Mamyrova G, Agarwal S, Jones OY, Bollar H, Huber AM, Rider LG, White PH. Parents' perception of self-advocacy of children with myositis: an anonymous online survey. Pediatr Rheumatol Online J 2011; 9:10. [PMID: 21649897 PMCID: PMC3118375 DOI: 10.1186/1546-0096-9-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 06/07/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children with complex medical issues experience barriers to the transition of care from pediatric to adult providers. We sought to identify these barriers by elucidating the experiences of patients with idiopathic inflammatory muscle disorders. METHODS We collected anonymous survey data using an online website. Patients and their families were solicited from the US and Canada through established clinics for children with idiopathic inflammatory muscle diseases as well as with the aid of a nonprofit organization for the benefit of such individuals. The parents of 45 older children/young adults suffering from idiopathic inflammatory muscle diseases were surveyed. As a basis of comparison, we similarly collected data from the parents of 207 younger children with inflammatory muscle diseases. The survey assessed transition of care issues confronting families of children and young adults with chronic juvenile myositis. RESULTS Regardless of age of the patient, respondents were unlikely to have a designated health care provider assigned to aid in transition of care and were unlikely to be aware of a posted policy concerning transition of care at their pediatrician's office. Additionally, regardless of age, patients and their families were unlikely to have a written plan for moving to adult care. CONCLUSIONS We identified deficiencies in the health care experiences of families as pertain to knowledge, self-advocacy, policy, and vocational readiness. Moreover, as children with complex medical issues grow up, parents attribute less self-advocacy to their children's level of independence.
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Affiliation(s)
- James D Katz
- Division of Rheumatology, The George Washington University, Washington, DC, USA.
| | - Gulnara Mamyrova
- Division of Rheumatology, The George Washington University, Washington, DC, USA
| | - Shilpi Agarwal
- Glendale Adventist Family Medicine Residency, Glendale, CA 91205, USA
| | - Olcay Y Jones
- Walter Reed Army Medical Center, Washington, DC 20307, USA
| | | | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | | | - Patience H White
- Division of Rheumatology, The George Washington University, Washington, DC, USA
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Maturo D, Powell A, Major-Wilson H, Sanchez K, De Santis JP, Friedman LB. Development of a protocol for transitioning adolescents with HIV infection to adult care. J Pediatr Health Care 2011; 25:16-23. [PMID: 21147403 DOI: 10.1016/j.pedhc.2009.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 11/03/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
Abstract
As HIV infection in childhood and adolescence has evolved from a terminal to a chronic illness, new challenges are posed for both medical and psychosocial teams serving these clients. Although specialized programs for transition to adult care have been reported for persons with cystic fibrosis, diabetes mellitus, sickle cell disease, and other chronic illnesses, there are few published reports of integral programs designed to transition adolescents who were infected with HIV during the adolescent period to adult HIV services. This article describes a model of transition from a University-based, federally funded adolescent HIV program to adult HIV services, addresses barriers to transition, and provides strategies and recommendations for improving adherence to the transition process.
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Affiliation(s)
- Donna Maturo
- University of Miami Miller School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Miami, FL33101, USA.
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Fair CD, Sullivan K, Gatto A. Best practices in transitioning youth with HIV: Perspectives of pediatric and adult infectious disease care providers. PSYCHOL HEALTH MED 2010; 15:515-27. [DOI: 10.1080/13548506.2010.493944] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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