Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa
BACKGROUND:Research on adolescent transitions out of pediatric HIV care has focused on high-income countries, with limited understanding of transitions in sub-Saharan Africa's public health sector. METHODS:Patient file data was extracted through December 2017 for all 10- to 19-year-olds ever in...
| Main Authors: | , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Lippincott, Williams and Wilkins
2019
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| _version_ | 1797105776668442624 |
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| author | Haghighat, R Toska, E Cluver, L Gulaid, L Mark, D Bains, A |
| author_facet | Haghighat, R Toska, E Cluver, L Gulaid, L Mark, D Bains, A |
| author_sort | Haghighat, R |
| collection | OXFORD |
| description | BACKGROUND:Research on adolescent transitions out of pediatric HIV care has focused on high-income countries, with limited understanding of transitions in sub-Saharan Africa's public health sector. METHODS:Patient file data was extracted through December 2017 for all 10- to 19-year-olds ever initiated on ART in a health district of the Eastern Cape, South Africa (n=951). Pathways in HIV care were identified by tracing movements across facility care types and levels. Associations between pathways and viral failure, mortality, loss to follow-up, and viral load change were tested in sequential multivariable regressions. Analyses controlled for sociodemographic and treatment-related variables. Thematic analyses of semi-structured healthcare provider interviews identified transition support at included facilities. RESULTS:Only 57.8% of adolescents had initiated ART in pediatric care, and 20.4% of the total cohort had transitioned out of pediatric HIV care. Among the 42.2% who had initiated in non-pediatric care, 93.8% remained exclusively in non-pediatric care. Median age at first transition was 14 years. Two main pathways were identified: classical transition to adult HIV care (43.3%) and down-referral transition to primary healthcare clinics (56.7%). Across pathways, 27.3% experienced cyclical transition, or repeated movement between pediatric and non-pediatric care. Independent of covariates, adolescents with down-referral transition were less likely to demonstrate viral failure (AOR 0.21 [95%CI 0.10-0.42], p<0.001). Mortality and loss to follow-up were not associated with either pathway. Median post-transition viral load change was not clinically significant (0.00 [IQR: 0.00-0.35]) or associated with transition pathways. Healthcare providers described informal "protocols" for mitigating risk of negative post-transition HIV outcomes. CONCLUSIONS:This study proposes a contextually relevant model for transitions out of pediatric HIV care in South Africa. Feasible, scalable "protocols" may mitigate risk of worsening post-transition HIV outcomes. |
| first_indexed | 2024-03-07T06:52:12Z |
| format | Journal article |
| id | oxford-uuid:fce9ca78-e61c-47d6-987a-7c3fc70b113e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T06:52:12Z |
| publishDate | 2019 |
| publisher | Lippincott, Williams and Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:fce9ca78-e61c-47d6-987a-7c3fc70b113e2022-03-27T13:24:49ZTransition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South AfricaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:fce9ca78-e61c-47d6-987a-7c3fc70b113eEnglishSymplectic Elements at OxfordLippincott, Williams and Wilkins2019Haghighat, RToska, ECluver, LGulaid, LMark, DBains, ABACKGROUND:Research on adolescent transitions out of pediatric HIV care has focused on high-income countries, with limited understanding of transitions in sub-Saharan Africa's public health sector. METHODS:Patient file data was extracted through December 2017 for all 10- to 19-year-olds ever initiated on ART in a health district of the Eastern Cape, South Africa (n=951). Pathways in HIV care were identified by tracing movements across facility care types and levels. Associations between pathways and viral failure, mortality, loss to follow-up, and viral load change were tested in sequential multivariable regressions. Analyses controlled for sociodemographic and treatment-related variables. Thematic analyses of semi-structured healthcare provider interviews identified transition support at included facilities. RESULTS:Only 57.8% of adolescents had initiated ART in pediatric care, and 20.4% of the total cohort had transitioned out of pediatric HIV care. Among the 42.2% who had initiated in non-pediatric care, 93.8% remained exclusively in non-pediatric care. Median age at first transition was 14 years. Two main pathways were identified: classical transition to adult HIV care (43.3%) and down-referral transition to primary healthcare clinics (56.7%). Across pathways, 27.3% experienced cyclical transition, or repeated movement between pediatric and non-pediatric care. Independent of covariates, adolescents with down-referral transition were less likely to demonstrate viral failure (AOR 0.21 [95%CI 0.10-0.42], p<0.001). Mortality and loss to follow-up were not associated with either pathway. Median post-transition viral load change was not clinically significant (0.00 [IQR: 0.00-0.35]) or associated with transition pathways. Healthcare providers described informal "protocols" for mitigating risk of negative post-transition HIV outcomes. CONCLUSIONS:This study proposes a contextually relevant model for transitions out of pediatric HIV care in South Africa. Feasible, scalable "protocols" may mitigate risk of worsening post-transition HIV outcomes. |
| spellingShingle | Haghighat, R Toska, E Cluver, L Gulaid, L Mark, D Bains, A Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa |
| title | Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa |
| title_full | Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa |
| title_fullStr | Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa |
| title_full_unstemmed | Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa |
| title_short | Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa |
| title_sort | transition pathways out of pediatric care and associated hiv outcomes for adolescents living with hiv in south africa |
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