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Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review.

Publication ,  Journal Article
Ritchwood, TD; Malo, V; Jones, C; Metzger, IW; Atujuna, M; Marcus, R; Conserve, DF; Handler, L; Bekker, L-G
Published in: BMC public health
August 2020

Adolescents living with HIV (ALWH) who transition from pediatric to adult care face several challenges that increase their risk of experiencing treatment interruptions and being lost to HIV care with resultant increased morbidity and mortality. To date, few studies have examined their outcomes post-healthcare transition (HCT), precluding the development and dissemination of evidence-based interventions aimed at retaining ALWH in HIV care both during and after HCT. We conducted a systematic review to synthesize the outcomes of ALWH post-HCT to provide suggestions for future directions.We systematically searched several electronic databases through October 2019 using keywords for HIV, HCT and ALWH. We categorized studies by target population, country (i.e., upper-high income and low-middle income), study design (i.e., descriptive, mixed methods, quantitative), outcomes measured, and follow-up period.A total of 24 studies met inclusion criteria. Studies were categorized according to the following HCT outcomes: retention in HIV care post-HCT (n = 13), changes in CD4+ count and viral load post-HCT (n = 16), and mortality among ALWH post-HCT (n = 7). Most studies (n = 11) examining retention in HIV care indicated that more than 70% of ALWH were retained in care 1-2 years post-HCT while the remaining studies (n = 2) reported retention rates less than 55%. While studies indicated that CD4+ counts and viral loads tended to worsen during the first few years post-HCT, these differences were often not statistically significant. Among all ALWH who transitioned to adult care, a small proportion died within their first seven years post-HCT. Among qualitative studies, common themes included transition readiness (n = 6), provider-patient relationship in the adult clinic setting (n = 6), and concern about the adult clinic setting (n = 4).Transition outcomes were poorest for ALWH with unsuppressed viremia pre-HCT, suggesting that this subgroup of ALWH may need greater support from their treatment teams and caregivers during and post-HCT to improve clinical outcomes.

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Published In

BMC public health

DOI

EISSN

1471-2458

ISSN

1471-2458

Publication Date

August 2020

Volume

20

Issue

1

Start / End Page

1195

Related Subject Headings

  • Viral Load
  • Transition to Adult Care
  • Qualitative Research
  • Public Health
  • Poverty
  • Patient Transfer
  • Male
  • Income
  • Humans
  • HIV Infections
 

Citation

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Ritchwood, T. D., Malo, V., Jones, C., Metzger, I. W., Atujuna, M., Marcus, R., … Bekker, L.-G. (2020). Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review. BMC Public Health, 20(1), 1195. https://doi.org/10.1186/s12889-020-09312-1
Ritchwood, Tiarney D., Vincenzo Malo, Cameron Jones, Isha W. Metzger, Millicent Atujuna, Rebecca Marcus, Donaldson F. Conserve, Lara Handler, and Linda-Gail Bekker. “Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review.BMC Public Health 20, no. 1 (August 2020): 1195. https://doi.org/10.1186/s12889-020-09312-1.
Ritchwood TD, Malo V, Jones C, Metzger IW, Atujuna M, Marcus R, et al. Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review. BMC public health. 2020 Aug;20(1):1195.
Ritchwood, Tiarney D., et al. “Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review.BMC Public Health, vol. 20, no. 1, Aug. 2020, p. 1195. Epmc, doi:10.1186/s12889-020-09312-1.
Ritchwood TD, Malo V, Jones C, Metzger IW, Atujuna M, Marcus R, Conserve DF, Handler L, Bekker L-G. Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review. BMC public health. 2020 Aug;20(1):1195.
Journal cover image

Published In

BMC public health

DOI

EISSN

1471-2458

ISSN

1471-2458

Publication Date

August 2020

Volume

20

Issue

1

Start / End Page

1195

Related Subject Headings

  • Viral Load
  • Transition to Adult Care
  • Qualitative Research
  • Public Health
  • Poverty
  • Patient Transfer
  • Male
  • Income
  • Humans
  • HIV Infections