ABSTRACT

Our objective was to determine facilitators and barriers to successful transition to adult care for adolescents living with perinatally-acquired HIV in South Africa. We prospectively enrolled 30 adolescents living with perinatally-acquired HIV after their pediatrician deemed them ready for transition to adult care but prior to their transition. Eighteen months after enrollment, we measured transition status, engagement in care (i.e., viral load within 12 months of transition), and viral suppression (<200 copies/ml). Additionally, we conducted in-depth interviews with adolescents before and after transition to explore facilitators and barriers to successful transition. A total of 19/30 (63%) adolescents transitioned to adult care. Of those who transitioned, 11 (58%) were retained in care and 7 (37%) were virally suppressed one year after transition to adult care. Insufficient staff training, lack of availability of pediatric ART formulations in adult clinics, and insufficient clinical monitoring contributed to delayed transition. Rigid clinical scheduling that interfered with school and loss of clinic relationships with peers and clinical staff were major factors in contributing to poor engagement in care after transition. Maturity of the adolescent, reduced distance to clinic, and reduced length of time in the clinic were seen as facilitators to transition to adult care. In conclusion, improved preparation for transition by pediatric and adult clinical staff, including restructuring of care delivery, may improve successful transition of adolescents living with perinatally acquired HIV to adult care. Transition readiness assessments are needed to determine optimal timing of transition and which adolescents are ready to transition to adult care.

摘要

我们的目标是确定南非围产期感染艾滋病毒青少年成功过渡到成人护理的促进因素和障碍。我们前瞻性地招募了 30 名围产期感染 HIV 的青少年，他们的儿科医生认为他们已准备好过渡到成人护理，但在他们过渡之前。入组后 18 个月，我们测量了过渡状态、参与护理（即过渡后 12 个月内的病毒载量）和病毒抑制（<200 拷贝/ml）。此外，我们在过渡前后对青少年进行了深入访谈，以探索成功过渡的促进因素和障碍。共有 19/30 (63%) 的青少年过渡到成人护理。在那些转型的人中，在过渡到成人护理一年后，11 人（58%）被保留在护理中，7 人（37%）被病毒抑制。工作人员培训不足、成人诊所缺乏儿科 ART 制剂以及临床监测不足导致过渡延迟。严格的临床日程安排会干扰学校以及与同行和临床工作人员失去临床关系是导致过渡后护理参与度低的主要因素。青少年的成熟度、到诊所的距离缩短和在诊所的时间缩短被视为向成人护理过渡的促进因素。总之，改善儿科和成人临床工作人员的过渡准备，包括重组护理服务，可能会促进围产期感染艾滋病毒的青少年成功过渡到成人护理。