Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers’ insights to create multi-level solutions to address transition barriers
Year: 2017
Type: article
Abstract: HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n = 28) and 20 adult clinics that receive transitioning adolescents (n = 30) from August 2015-June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents' transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers' ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.
Source: AIDS Care
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: green
Funders: Children's Hospital of Philadelphia, University of Miami, Wayne State University, Texas Children's Hospital, Tulane University, Johns Hopkins University, University of Alabama at Birmingham, University of South Florida, Mental Health Research UK, Children's National Hospital, National Institutes of Health, National Institute on Drug Abuse, National Institute of Child Health and Human Development, National Institute on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development
OpenAlex ID: W2622645128