Transition of Adolescents With HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions

doi:10.1016/j.jana.2010.04.003

Journal of the Association of Nurses in AIDS Care

Volume 22, Issue 4, July–August 2011, Pages 283-294

https://doi.org/10.1016/j.jana.2010.04.003 Get rights and content

The transition process from pediatric to adult health care for adolescents with chronic diseases is always challenging and can be even more so for adolescents with HIV disease. The purpose of this study was to describe characteristics and current practices surrounding the transition of adolescents from the clinics of the Adolescent Trials Network for HIV/AIDS Interventions to adult medical care. This report focuses on the processes of transition, perceived barriers and facilitators, and anecdotal reports of successes and failures. Practice models used to assist adolescents during transition to adult medical care are described. Interviews were conducted with 19 key informants from 14 Adolescent Trials Network clinics. Findings revealed no consistent definition of “successful” transition, little consensus among the sites regarding specific elements of a transition program, and a lack of mechanisms to assess outcomes. Sites that viewed transition as a process rather than an event consistently described more structured program elements.

Section snippets

Participants and Procedure

The ATN for HIV/AIDS Interventions is a multicenter collaborative network funded by the NIH to study the HIV/AIDS epidemic in adolescents. Relevant leadership groups within the ATN and respective site leadership agreed to this research collaboration, and internal review board approval was obtained from the University of South Florida. Site representatives were recruited from eligible ATN clinic sites, and all eligible sites participated. Puerto Rico and Tulane clinic in New Orleans were

Demographics

The 14 ATN sites represented in this study were located in Chicago (2), New York (2), and one each in Boston, Philadelphia, Washington DC, Baltimore, Memphis, Tampa, Ft. Lauderdale, Miami, Los Angeles, and San Francisco. At the time of this study, these 14 clinics managed a total of 1,775 patients ages 13 to 25 years. There were 31-266 patients at each site in this age group.

The clinic populations were described by a variety of demographic variables that were not mutually exclusive. The

Discussion

Despite the absence of a standard definition of transition, we did find some trends across sites that suggested positive outcomes after transition. Six of the ATN sites had developed formalized approaches to HCT. All of the sites that used a formalized approach reported using collaborative transition teams, a developmental approach, and planned activities to facilitate patient education and skill building. These activities were initiated early and reinforced frequently. Each of these sites

Disclosures

The authors report no real or perceived vested interests that relate to this article (including relationships with pharmaceutical companies, biomedical device manufacturers, grantors, or other entities whose products or services are related to topics covered in this manuscript) that could be construed as a conflict of interest.

Patricia P. Gilliam, PhD, MEd, NP, is a Nurse Practitioner, St. Joseph's Hospital Tampa Care Clinic, Tampa, Florida, USA.

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The findings highlight key aspects of the pediatric nurse role in HCTP and identify specific elements that can be addressed to support future HCTP role development.
Pediatric nurses perform a vital role in HCTP for YYA with CID that may be enhanced with the inclusion of HCTP activities in job descriptions and specialized interdisciplinary HCTP training related to this emerging and growing population.
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Patricia P. Gilliam, PhD, MEd, NP, is a Nurse Practitioner, St. Joseph's Hospital Tampa Care Clinic, Tampa, Florida, USA.

Jonathan M. Ellen, MD, is a Professor of pediatrics, Deputy Chief of Adolescent Medicine, Johns Hopkins University College of Medicine, Baltimore, Maryland, USA.

Lori Leonard, ScD, is an Associate Professor, Department of Health, Behavior & Society, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.

Sara Kinsman, MD, PhD, is an Assistant Professor of Clinical Pediatrics, Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Cecilia M. Jevitt, CNM, PhD, is an Associate Professor, Midwifery & Nursing, University of South Florida Colleges of Nursing & Medicine, Tampa, Florida, USA.

Diane M. Straub, MD, MPH, is an Associate Professor of pediatrics, Chief, Division of Adolescent Medicine, University of South Florida College of Medicine, Tampa, Florida, USA; and the Adolescent Trials Network for HIV/AIDS Interventions.

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FeatureTransition of Adolescents With HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions

Section snippets

Participants and Procedure

Demographics

Discussion

Disclosures

Journal of Adolescent Health

Journal of Adolescent Health

Journal of Pediatric Nursing

Life expectancy of individuals on combination antiretroviral therapy in high-income countries: A collaboration analysis of 14 cohort studies

Lancet

A consensus statement on health care transitions for young adults with special health care needs from the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians American Society of Internal Medicine

Pediatrics

Children and adolescents living with HIV and AIDS: A review

Journal of Child Psychiatry

Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-2 infection

Journal of the American Medical Association

HIV in adolescents and young adults: Half of all new infections in the United States

Topics in HIV Medicine

Feature
Transition of Adolescents With HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions