CLINICAL OUTCOMES OF ADOLESCENTS LIVING WITH HIV AFTER TRANSFER TO ADULT CARE IN ETHIOPIA: A RETROSPECTIVE COHORT STUDY
Keywords:Adolescents, Antiretroviral, HIV, Perinatal Infection, Transition, Lost to follow up
Introduction: Transferring of adolescents living with HIV from pediatric care to adult care, is beyond changing the location of the services. The transition process will greatly affect the success of treatment for individual patients. The aim of this study was to assess the clinical outcomes of adolescents who were transferred to adult care.
Methods: Facility-based retrospective cohort study based on a review of the clinical records of adolescents who were transferred from pediatric clinic to adult clinic from January 2016 to 31 December 2017 in Tikur Anbessa Specialized Hospital. Data was extracted from paper-based and electronic medical records using a structured data abstraction tool. Data were analyzed using SPSS version 24.
Result: Out of the 151 patients, 18 (11.9%) of them were lost to follow up after one year of transfer to adult care. There was one death, which occurred three months after the transfer. At the time of transfer, 11(7.5%) of adolescents had poor adherence, and after six months of the transfer, this number has increased to 52(34.4%). The number of adolescents with CD4 count < 200 cells/μl has increased from 2.7% (at time of transfer) to 13.2%( six months of transfer).
Conclusion: Although the majority (87.4%) of adolescents remained engaged in their follow-up after transfer to adult care, there is a major gap in adherence, and these also reflected by a subsequent increment of patients who have a CD4 count less than 200 cells/μl. This suggests that more should be done to ease the transition process of adolescents.
Gilliam PP, Ellen JM, Leonard L, Kinsman S, Jevitt CM, Straub DM. Transition of adolescents with HIV to adult care: characteristics and current practices of the adolescent trials network for HIV/AIDS interventions. Journal of the Association of Nurses in AIDS Care. 2011 Jul 1;22(4):283-94.
Lee S, Hazra R. Achieving 90–90–90 in paediatric HIV: adolescence as the touchstone for transition success. Journal of the International AIDS Society. 2015 Dec;18:20257.
Lowenthal ED, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. The Lancet infectious diseases. 2014 Jul 1;14(7):627-39.
Folayan MO, Odetoyinbo M, Brown B, Harrison A. Addressing the socio-development needs of adolescents living with HIV/AIDS in Nigeria: a call for action. African journal of reproductive health. 2014;18(3):93-101
Kim MH, Mazenga AC, Devandra A, Ahmed S, Kazembe PN, Yu X, Nguyen C, Sharp C. Prevalence of depression and validation of the Beck Depression Inventory‐II and the Children's Depression Inventory‐Short amongst HIV‐positive adolescents in Malawi. Journal of the International AIDS Society. 2014 Jan;17(1):18965
Meless GD, Aka‐Dago‐Akribi H, Cacou C, François Eboua T, Edmond Aka A, Maxime Oga A, Bouah B, Eugene M, Moh C, Arrivé E, Timité‐Konan M. Notification of HIV status disclosure and its related factors in HIV‐infected adolescents in 2009 in the Aconda program (CePReF, CHU Yopougon) in Abidjan, Côte d'Ivoire, The PRADO‐CI Study. Journal of the International AIDS Society. 2013 Jan;16(1):18569
Mellins CA, Tassiopoulos K, Malee K, Moscicki AB, Patton D, Smith R, Usitalo A, Allison SM, Van Dyke R, Seage III, for the Pediatric HIV-AIDS Cohort Study GR. Behavioral health risks in perinatally HIV-exposed youth: co-occurrence of sexual and drug use behavior, mental health problems, and nonadherence to antiretroviral treatment. AIDS patient care and STDs. 2011 Jul 1;25(7):413-22.
MacDonell K, Naar-King S, Huszti H, Belzer M. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS and Behavior. 2013 Jan 1;17(1):86-93.
Kakkar F, Van der Linden D, Valois S, Maurice F, Onnorouille M, Lapointe N, Soudeyns H, Lamarre V. Health outcomes and the transition experience of HIV-infected adolescents after transfer to adult care in Quebec, Canada. BMC pediatrics. 2016 Dec;16(1):109.
Hussen SA, Chakraborty R, Knezevic A, Camacho‐Gonzalez A, Huang E, Stephenson R, del Rio C. Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study. Journal of the International AIDS Society. 2017;20(1):21848.
Koech E, Teasdale CA, Wang C, Fayorsey R, Alwar T, Mukui IN, Hawken M, Abrams EJ. Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya. AIDS (London, England). 2014 Nov 28;28(18):2729.
World Health Organization. Health for the world's adolescents: a second chance in the second decade: summary. World Health Organization; 2014.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. World Health Organization; 2016.
National Consolidated guidelines for comprehensive HIV prevention, care and treatment. Federal Minstry of Health, August 2018.
Weijsenfeld AM, Smit C, Cohen S, Wit FW, Mutschelknauss M, Van Der Knaap LC, Van Zonneveld LM, Zomer BJ, Nauta N, Patist JC, Kuipers-Jansen MH. Virological and social outcomes of HIV-infected adolescents and young adults in the Netherlands before and after transition to adult care. Clinical Infectious Diseases. 2016 Oct 15;63(8):1105-12.
Sidibé M, Loures L, Samb B. The UNAIDS 90–90–90 target: a clear choice for ending AIDS and for sustainable health and development. Journal of the International AIDS Society. 2016;19(1).