Transition Pathways Out of Pediatric Care and Associated HIV Outcomes for Adolescents Living With HIV in South Africa
Year: 2019
Type: article
Study design: Observational Study
Abstract: 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 were extracted through December 2017 for all 10- to 19-year olds ever initiated on antiretroviral therapy 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 semistructured health care provider interviews identified transition support at included facilities. RESULTS: Only 57.8% of adolescents had initiated antiretroviral therapy 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 nonpediatric care, 93.8% remained exclusively in nonpediatric 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 health care clinics (56.7%). Across pathways, 27.3% experienced cyclical transition or repeated movement between pediatric and nonpediatric care. Independent of covariates, adolescents with down referral transition were less likely to demonstrate viral failure (adjusted odds ratio, 0.21; 95% confidence interval: 0.10 to 0.42; P < 0.001). Mortality and loss to follow-up were not associated with either pathway. Median posttransition viral load change was not clinically significant (median, 0.00; interquartile range: 0.00-0.35) or associated with transition pathways. Health care providers described informal "protocols" for mitigating risk of negative posttransition 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 posttransition HIV outcomes.
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Funders: United States Agency for International Development, U.S. Department of Veterans Affairs, UNICEF, Leverhulme Trust, Nuffield Foundation, University of Oxford, European Commission, International AIDS Society, National Institutes of Health, Medical Research Council, Economic and Social Research Council, Research England, Clarendon Fund, Fogarty International Center, H2020 European Research Council, FP7 Ideas: European Research Council
Awards: G1098435007, G1761045354, G217504945, G225013618, G248017920, G2605859761, G2723030772, G2973790809, G3207356259, G3287478490, G393177772, G4056298613, G434337789, From Stop to Go! Overcoming barriers to healthcare utilisation for high-risk adolescent mothers and their children in Southern Africa., G4756899495, G4969981848, G5702163051, G5793669600, G6228686552, CAPITA: Child Abuse Prevention International Training and Access, G708721562, Preventing Abuse of Children in the Context of AIDS in sub-Saharan Africa, G764948329, G7689853932, G8205473977, G8612518590
OpenAlex ID: W2962995290