Managing the transition from paediatric to adult care for HIV, Kenya
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Authors
Njuguna, Irene; Beima-Sofie; Kristin, Mburu; Caren, Mugo; Cyrus, Black; Danae A;Neary, Jillian; Itindi, Janet; Onyango, Alvin; Slyker, Jennifer; Oyiengo, Laura; John-Stewart, Grace;Wamalwa, Dalton
Issue Date
2019
Type
Journal / periodical articles
Language
Keywords
Policy and Practice;HIV;Paediatric; Adult care;Kenya
Alternative Title
Abstract
Description
Expansion of access to diagnosis and treatment for human immunodeficiency virus (HIV) and a high incidence of HIV infection
in adolescence has resulted in a growing population of adolescents and young adults living with HIV. The prevalence of poor retention in
care, insufficient viral suppression and loss to follow-up are higher among adolescents and young adults compared with other age groups.
Poor outcomes could be attributed to psychosocial changes during adolescence, but also to poor transitional care from paediatric to adult
HIV services. In many countries, transition processes remain poorly defined and unstructured, which may jeopardize treatment adherence
and retention. We describe existing definitions of transition and transition frameworks, and key elements of transition as proposed by key
national stakeholders in Kenya. Our consensus definition of transition is “a planned process by which adolescents and young adults living
with HIV, and their caregivers, are empowered with knowledge and skills to enable them to independently manage their health.”Transition
should begin soon after disclosure of HIV status until an adolescent gains the necessary knowledge and skills and is willing to move to
adult services, or by 25 years of age. Proposed key elements of transition are: target ages for milestone achievement; readiness assessment;
caregiver involvement and communication with adult clinics; flexibility to return to adolescent or paediatric clinics; group transition; and
considerations for adolescents with special needs. Retention in care, linkage to care and viral suppression are important markers of transition
success. Proposed definitions and key elements could provide a framework for structuring transition programmes in other countries.
Citation
Publisher
WHO