Transitioning HIV+ Adolescents to Adult Care: Exploring Adolescent and Adult Medicine Clinics Role in the Process
Condition: HIV
Study type: Observational

Summary: 
      This is a multi-site, longitudinal study and it describes the transition process of
      behaviorally-infected HIV-positive youth as they move from pediatric- and adolescent-specific
      care to adult care. To achieve this goal, the transition process is characterized from the
      perspectives of HIV-positive youth, Adolescent Medicine Trials Unit (AMTU) clinic staff, and
      receiving adult clinic staff.
    

Detailed description: 
      The changes associated with transition to adult clinical care may increase the likelihood
      that an adolescent will drop out of care, which results in poorer outcomes. Disengagement
      from care has implications for health. Disruption in medication can increase viral load (VL),
      and intensify the potential for co-morbidities and transmission efficiency . Thus, successful
      transition to adult care is especially important for HIV-positive adolescents (compared to
      other chronic diseases) as they will need to maintain clinic visits and medication adherence
      across their lifespan to remain healthy and maintain a low VL to reduce the potential for
      transmission in the context of other developmental and psychosocial changes and challenges.
      The ultimate goal of this study is to represent the key places - youth, adolescent clinic and
      adult clinic - where transition interventions could be targeted and to collect data to
      capture the key elements and modifiable variables at each level. This study will contribute
      to existing research by providing transition research on HIV, which differs from other
      congenital or acquired chronic conditions due to it being an infectious disease; by
      prospectively following youth as they transition; and by providing transition research from
      the perspective of receiving adult clinics. It will also illustrate how each level- youth,
      adolescent clinic and adult clinic - is situated within a specific context and how these
      levels interact to affect transition outcomes.

      This is a multi-method, longitudinal design research study. Subjects must be enrolled in ATN
      125 at the time of the ATN 135 baseline visit. There will be no randomization procedures.
      During the 39-week study, surveys will be administered to adolescents and young adults
      transitioning to adult care via Audio Computer Assisted Self Interviews (ACASIs), which will
      collect data on individual (e.g., psychosocial and behavioral) and clinical factors affecting
      transition at 0 and 39 weeks. Demographic, biomedical, antiretroviral therapy (ART) and
      healthcare utilization visit information collected through ATN 125 medical chart abstraction
      will also become part of the ATN 135 subject dataset. One-time phone surveys and interviews
      with AMTU and adult clinic staff will also be conducted to collect information on transition
      protocols as well as review of any documentation of existing transition protocols (e.g.,
      transitioning SOP). Outcome measures will include pre- and post-transition VL and other
      measures of physical and psychosocial health status to compare individuals with different
      patterns and outcomes of transition.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Behaviorally-infected HIV-positive adolescents and young adults between the ages of 18 and
        24 years, are recruited to complete computer assisted interviews to characterize the
        transition process and outcomes.

        AMTU staff and partner adult clinic staff are recruited to complete quantitative surveys
        and semi-structured interviews over the phone to explore transition processes and
        protocols. There are no minimum or maximum age criteria that staff must meet .
      
Keywords: Pediatric; HIV; Transition; Adult Care