Ali Judd1, Mary-Ann Davies2. 1. MRC Clinical Trials Unit at UCL, University College London, London, UK. 2. Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Abstract
PURPOSE OF REVIEW: To summarize evidence for health outcomes among adolescents and young people living with HIV (AYLHIV) who have transitioned to adult care/adulthood, views of AYLHIV and providers on the transition process, and the effect of adolescent and youth friendly services (AYFS) on outcomes. RECENT FINDINGS: A total of 43 studies were identified [n = 13 high-income countries (HICs), n = 30 low-/middle-income countries (LMICs)]. In HICs, around 75% of patients were retained in care at approximately 4 years posttransition. In LMICs, retention worsened from older adolescence into young adulthood. Across both contexts, comparisons of mortality, immunological, and virological outcomes were hampered by a limited number of studies and/or different definitions and study durations. AYLHIV and providers reported several factors that could aid transition and AYFS had generally positive outcomes. SUMMARY: Overall, outcomes varied by study and context; direct comparison was severely hampered by the inclusion of different populations of AYLHIV (sometimes with small numbers and a lack of comparison groups), the use of different outcome definitions, varying follow-up duration, and the lack of a specific transition process in LMICs. Future studies need to consider harmonizing definitions and implementing unique patient identifiers, and data linkage techniques to improve the evidence base on long-term outcomes.
PURPOSE OF REVIEW: To summarize evidence for health outcomes among adolescents and young people living with HIV (AYLHIV) who have transitioned to adult care/adulthood, views of AYLHIV and providers on the transition process, and the effect of adolescent and youth friendly services (AYFS) on outcomes. RECENT FINDINGS: A total of 43 studies were identified [n = 13 high-income countries (HICs), n = 30 low-/middle-income countries (LMICs)]. In HICs, around 75% of patients were retained in care at approximately 4 years posttransition. In LMICs, retention worsened from older adolescence into young adulthood. Across both contexts, comparisons of mortality, immunological, and virological outcomes were hampered by a limited number of studies and/or different definitions and study durations. AYLHIV and providers reported several factors that could aid transition and AYFS had generally positive outcomes. SUMMARY: Overall, outcomes varied by study and context; direct comparison was severely hampered by the inclusion of different populations of AYLHIV (sometimes with small numbers and a lack of comparison groups), the use of different outcome definitions, varying follow-up duration, and the lack of a specific transition process in LMICs. Future studies need to consider harmonizing definitions and implementing unique patient identifiers, and data linkage techniques to improve the evidence base on long-term outcomes.
Authors: Brian C Zanoni; Moherndran Archary; Tamarra Subramony; Thobekile Sibaya; Christina Psaros; Jessica E Haberer Journal: AIDS Behav Date: 2021-01