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Transition Program of HIV-infected adolescents to Adult HIV care in Buenos Aires, Argentina

Transition Program of HIV-infected adolescents to Adult HIV care in Buenos Aires, Argentina. S. Arazi Caillaud 1 , D. Mecikovsky 1 , A.Bordato 1 , J.Lattner 2 , L.Spadaccini 2 , C.Rodríguez 3 , R. Posada 4 , P.Cahn 2 , R. Bologna 1.

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Transition Program of HIV-infected adolescents to Adult HIV care in Buenos Aires, Argentina

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  1. Transition Program of HIV-infected adolescents to Adult HIV care in Buenos Aires, Argentina S. Arazi Caillaud1, D. Mecikovsky1, A.Bordato1, J.Lattner2, L.Spadaccini2, C.Rodríguez3, R. Posada4, P.Cahn2, R. Bologna1 1Hospital de Pediatría Dr J. P. Garrahan, Buenos Aires, Argentina 2Hospital Fernández, Buenos Aires, Argentina 3 HospitalCosme Argerich, Buenos Aires, Argentina 4 Mount Sinai School of Medicine, New York, USA

  2. Background • Withadvances in ARV therapymost HIV-infectedchildrensurviveintoadulthood • Optimal health care includes a formal plan for the transition of care from primary pediatric care to adult health-care providers • Transitioning difficulties include changes of puberty, factors related to HIV infection (disclosure, stigma, parental loss, poor treatment adherence, poverty, sexual life), family resistance, and limited training of health professionals Scal P,. J Adolesc Health. 1999;24:259-264

  3. Background • Facilitators: • Transition planning • Introduction of concept of transition to patient and family • Education and empowerment: • Independence, autonomy, and decision making • Health education: disease understanding • Ways to obtain solutions from health professionals • Rationale of antiretroviral treatment • Psychosocial support Committee on Pediatric AIDS Pediatrics 2013; 132: 192-197

  4. Transition Program in Buenos Aires, Argentina Hospital de Pediatría Garrahan 507 HIV-infected children in follow-up Median age: 12 years (0.3-21) Buenos Aires ARGENTINA • Argentina has a prevalence of 130,000 HIV cases, with 100 (70-120) children newly infected per year • Free access to HIV treatment (ART + care)

  5. Transition Program • Pilot project: 2007 (cross- sectional review) • Transition program: 2008-2013 • Phase 1: • Team activities (local team, identification of potential adult-care centers, development of guidelines, communication plan, registry) • Patient and family activities (Transition Clinic, workshops, peer support groups): risk reduction, empowerment, autonomy, how to “navigate” the new hospital ) • Phase 2: Actual transition to adult care • Phase 3: Monitoring and Evaluation

  6. Pilot Study: Baseline characteristics (N:85)

  7. Transition Program • Pilot project: 2007 (cross- sectional review) • Transition program: 2008-2013 • Phase 1: • Team activities (local team, identification of potential adult-care centers, development of guidelines, communication plan, registry) • Patient and family activities (Transition Clinic, workshops, peer support groups): to provide support and risk reduction counseling, help them to “navigate” the new hospital • Phase 2: Actual transition to adult care • Phase 3: Monitoring and Evaluation

  8. Workshops – Peer support groups • Multimedia sessions: • Interactive activities • Videos • Different means of communication (SMS, dropbox, telephone calls) • Transition clinic with more flexible appointments • Medical and social history was communicated to accepting provider by a physician • Guide to “navigate” the new hospital has been designed

  9. Welcome to the Infectious Diseases Unit

  10. Materials and methods • Prospective, observational study • Setting: Hospital de Pediatría Dr J.P.Garrahan • Adult centers(receptors): Hospital Fernández • Hospital Argerich • Population: adolescents HIV infected as children > 16 years enrolled at the pediatric hospital, and transferred to adult health-care centers between 06/2007 and 12/2013 • Aim of the study: to evaluate the transition program • Transition was considered successful when at least 2 clinic visits and 1 viral load testing took place at an adult-care center within 6 months after referral • Demographic, clinical, virological, and social characteristics of adolescents at the time of transition were evaluated • To evaluate the contingency tables Fisher or Chi square Tests were used.

  11. Results

  12. Transitioned N=130 Results 72.3%

  13. Results Variables associated with transition outcome

  14. Conclusions • A program with clear goals and specific strategies to support and prepare adolescents for the transition process has been associated with high rates of successful transitioning of HIV infected adolescents • The rate of successful transitioning was 72.3% and most of the patients were virologically suppressed (63%) with a median CD4 count >500 céls/mm3 • Adequately caring for his/her own health has been associated with successful transition • Lack of adherence to clinic appointments has been associated with transition failure • Substance use and not attending formal educationcould be risk factors for transition • Special focus on autonomy, prior adherence, and psychosocial support need to be ensured

  15. Acknowledgements We would like to thank the patients who participated in this program and their families, all health care personnel and volunteers Fogarty AITRP #5D43 TW001037 Adult Health care Team (ID, Mental health, social worker ) Pediatric Team (ID, Mental health, ginecologist, social worker )

  16. Results Habits and social characteristics of patients in transition

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