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.

TitleTransitioning 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.
Publication TypePublication
Year of Publication2017
AuthorsPhilbin MM, Tanner AE, Chambers BD, Ma A, Ware S, Lee S, J Fortenberry D
JournalAIDS Care
Volume29
Issue10
Pagination1227-1234
Date Published2017 10
ISSN1360-0451
KeywordsAdolescent, Adult, Ambulatory Care Facilities, Attitude of Health Personnel, Health Personnel, Health Services Accessibility, Healthcare Disparities, HIV Infections, Humans, Problem Solving, Social Stigma, Social Support, Transition to Adult Care, United States
Abstract

<p>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.</p>

DOI10.1080/09540121.2017.1338655
Alternate JournalAIDS Care
PubMed ID28599596
PubMed Central IDPMC5573205
Grant ListU01 HD040533 / HD / NICHD NIH HHS / United States
U01 HD040474 / HD / NICHD NIH HHS / United States
U01 HD032842 / HD / NICHD NIH HHS / United States
L60 MD009069 / MD / NIMHD NIH HHS / United States
K01 DA039804 / DA / NIDA NIH HHS / United States