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UNICEF-2012

Transitioning care, support, and treatment services for ALHIV: Evidence on Transition Melissa Sharer AIDSTAR-One. An estimated 2 million adolescents aged 10 - 19 were living with HIV in 2009, 65% of them adolescent girls. UNICEF-2012. Progress strong, the future is hopeful.

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UNICEF-2012

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  1. Transitioning care, support, and treatment services for ALHIV: Evidence on TransitionMelissa SharerAIDSTAR-One

  2. An estimated 2 million adolescents aged 10 - 19 were living with HIV in 2009, 65% of them adolescent girls UNICEF-2012

  3. Progress strong, the future is hopeful. • Perinatally infected: • Fast Progressors-64% median survival 6-7 months • Slow Progressors-36% median survival age 16 WITHOUT treatment • Those on trx are also expected to live longer

  4. Estimates on ALHIV in SSA Adolescents 10-19 Living with HIV ? Vertically Infected 1.2 Million Youth 15-24 Living with HIV 2.7 Million Behaviorally Infected Sources: UA & OIC - 2011 UNICEF-2012

  5. Perinatally vs. Behaviorally

  6. However NEEDS are similar

  7. Transition must address: • Barrier: Stigma • Barrier: Grief, loss, and bereavement • Barrier: Beneficial Disclosure (WHO 2011) • Barrier: SRH • Barrier: Substance Use (?) • Barrier: Mental Health and Neurocognitive (?) • Barrier: Family care models • Barrier: Providers sensitive to family and youth • Barrier: Focus on self management throughout

  8. Adolescence a time of physical and mental transition • May have no physical move, but mentally adolescent is a time of great growth and change • “a multifaceted, active process that attends to the medical, psychological, and educational or vocational needs of adolescents as they move from the child focused to the adult focused health care ” -(Reiss and Gibson 2002, pg 1309)

  9. Counseling and Testing Family/caregiver COUNSELING and TESTING and PICT is a key way to catch this group earlier. However key concerns remain….consent, counseling, and confidentiality. Barrier: Knowing your status!

  10. Reaching Adolescents through Testing Current: WHO Developing Guidance now to help improve diagnosis and timely initiation into care and treatment for adolescents living with HIV.

  11. How: The Evidence • Botswana Baylor: • Clinic opened in 2003 <30 adolescents, now >600. • Holistic service model • No RCT, but expert opinion and scale up in Zambia, Uganda, Kenya, Swazi, Lesotho. • SA Collaborative HIV adolescent MH program (CHAMP) • Multi-country model that builds social networks and peer support to strengthen autonomy. • RCT showing strengthened protective factors associated with less-risky behaviors for adolescents (Bell 2008). • Zimbabwe Zvandiri Program: • Bidirectional linkages community and clinics. • No RCT but expert opinion and SADC best practice

  12. Zimbabwe ZvandiriProgramme

  13. So…. • How to minimize barriers? • How to move towards self-management? • How to identify and integrate a service package into standard care?

  14. PEPFAR’s Response via Africa Bureau POLICY: Technical Brief- Broad overview of care for adolescents while transitioning July 2012 PRACTICE: A Transition Toolkit: Focus on increasing QoC and holistic care for ALHIV Forthcoming via Pilot in Kenya, Zambia, Mozambique SOUTH TO SOUTH SHARING: Workshop to share country experience, to have youth participation/leadership, to finalize TB & TK February 2012

  15. Transition Model of Care (adapted from Movin’ Out Model, Maturo et al., 2011)

  16. Comprehensive Transition Checklist

  17. HOPE going forward into transition…. “Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible.” -St Francis of Assissi

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