Determinants of successful transition from adolescent to adult HIV treatment in Zambia: a facility-level based comparative study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20243272Keywords:
Adolescents, Adult HIV, Facility-level, Transition, Viral load suppressionAbstract
Background: Successful transition from adolescent to adult care has not been extensively evaluated, in Zambia. The study aimed to assess the relationship between facility-based socio-demographic traits and successful transition to adult HIV care, in Zambia.
Methods: A retrospective descriptive cross-sectional analysis of 7275 patient files from 718 PEPFAR sponsored facilities. Data was extracted from the National Electronic Health Record (EHR) system and imported into STATA SE v-16 for analysis. Descriptive statistics were calculated on socio-demographic features and facility-level performance. Logistic regression was used to analyse the association between level of facility and successful transition to adult care, comparing third level facilities to lower-level facilities. Chi-square was employed to evaluate the association between socio-demographic traits and effective transition outcomes at a significance level of 0.05.
Results: 43.2% had successfully transitioned to adult care. Health posts performed the best, with 57.3% of patients successfully transitioning to adult care. The study found that health post type, private ownership, rural location, and province were significant factors in successful transition. Adolescents in lower-level facilities had a 59.9% success rate compared to those in third-level facilities.
Conclusions: The study stresses the importance of health system structure and posits that successful transition depends on many factors, not simply adolescent traits.
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References
World Health Organisation (WHO). HIV/AIDS Factsheet, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/hiv-aids. Accessed on 21 May 2024.
United Nations International Children Emergency Fund (UNICEF), 2020, Pediatric Care and Treatment, Fast Fact. Available from: https://data.unicef.org/topic/hivaids/paediatric-treatment-and-care/. Accessed on 21 May 2024.
Dahourou L, Gautier-Lafaye C, Teasdale A, Renner L, Yotebieng M, Desmonde S, Transition from paediatric to adult care of adolescents living with HIV in sub-Saharan Africa: challenges, youth-friendly models, and outcomes. J Int AIDS Soc. 2017;20:21528.
Zanoni BC, Archary M, Sibaya T, Musinguzi N, Haberer JE, Transition from pediatric to adult care for adolescents living with HIV in South Africa: a natural experiment and survival analysis. 020;15(10):e0240918.
Masese RV, Ramos JV, Rugalabamu L, Luhanga S, Shayo AM, Stewart KA, et al. Challenges and facilitators of transition from adolescent to adult HIV care among young adults living with HIV in Moshi, Tanzania. J Int AIDS Soc. 2019;22(10).
Irene N, Kristin S, Caren M, Cyrus M, Danae A. B, Jillian, et al, 2019, Managing the transition from paediatric to adult care for HIV, Kenya. Bulletin of the World Health Organisation. Policy Pract. 2019;97(12):837.
Jegede OE, van Wyk B. Transition interventions for adolescents on antiretroviral therapy on transfer from pediatric to adult healthcare: a systematic review. Int J Environ Res Public Health. 2022;19(22):14911.
Petinger C, Crowley T, van Wyk B. Experiences of adolescents living with HIV on transitioning from pediatric to adult HIV care in low and middle-income countries: a qualitative evidence synthesis protocol. PLoS One. 2024;19(2):e0296184.
Mark D, Armstrong A, Andrade C, Penazzato M, Hatane L, Taing L, et al. HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub‐Saharan African countries. J Int AIDS Soc. 2017;20:21591.
UNAIDS. Ending AIDS: Progress towards the 90-90-90 Targets. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS; 2017.
Haghighat R, Toska E, Cluver L, Gulaid L, Mark D, Bains A. Transition pathways out of pediatric care and associated HIV outcomes for adolescents living with HIV in South Africa. JAIDS J Acquired Immune Def Syndr. 2019;82(2):166-74.
Agwu AL, Lee L, Fleishman JA, Voss C, Yehia BR, Althoff KN, et al. Aging and loss to follow-up among youth living with human immunodeficiency virus in the HIV Research Network. J Adolesc Health. 2015;56(3):345-51.
Ministry of Health, Republic of Zambia. National Health Strategic Plan 2011-2015. Available from: https://www.uhc2030.org/fileadmin/uploads/ihp/Documents/Country_Pages/Zambia/ZambiaNHSP2011to2015final..pdf. Accessed on 21 May 2024.
Wright J. Health Finance and Governance Project. Essential Package of Health Services Country Snapshot: Mali. Bethesda, MD: Health Finance and Governance Project, Abt Associates Inc.; 2015.
UNAIDS Country Factsheet, Zambia, 2018. Available from: https://www.unicef.org/ zambia/hivaids. Accessed on 21 May 2024.
Judd A, Davies MA. Adolescent transition among young people with perinatal HIV in high-income and low-income settings. Curr Opin HIV AIDS. 2018;13(3):236-48.
Masese RV, Ramos JV, Rugalabamu L, Luhanga S, Shayo AM, Stewart KA, et al. Challenges and facilitators of transition from adolescent to adult HIV care among young adults living with HIV in Moshi, Tanzania. Afr J Reprod Gynaecol Endosc. 2019;22(10).
Tanner AE, Philbin MM, Ma A, Chambers BD, Nichols S, Lee S, et al. Adolescent to adult HIV health care transition from the perspective of adult providers in the United States. J Adolesc Health. 2017;61(4):434-9.
Stephanie T, Chanda M, Anjali S, Njekwa M, Laura B, Elvin G, et al. Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care. PloS One. 2018;13(3):e0193641.
Mesic A, Halim N, MacLeod W, Haker C, Mwansa M, Biemba G. Facilitators and barriers to adherence to antiretroviral therapy and retention in care among adolescents living with HIV/AIDS in Zambia: a mixed methods study. AIDS Behav. 2019;23:2618-28.
Valenzuela M, Buchanan L, Radcliffe J, Ambrose C, Hawkins A, Tanney M. Transition to adult services among behaviourally infected adolescents with HIV- a qualitative study. J Pediatr Psychol. 2011;36(2):134-40.
Mbalinda SN, Bakeera-Kitaka S, Lusota DA, Musoke P, Nyashanu M, Kaye DK. Transition to adult care: exploring factors associated with transition readiness among adolescents and young people in adolescent ART clinics in Uganda. PLoS One. 2021;16(4):e0249971.
Ssemata AS, Nakasujja N, Kinyanda E. Transitioning from paediatric to HIV adult care services for adolescents and young people living with HIV in the African region: a scoping review protocol. BMJ Open. 2022;12:e059241.
Rakhmanina N, Corrigan B, Kose J, Ruffell C, Barnes P, Manson K. Approaches to Care for the HIV-Infected Adolescents across National HIV/AIDS Programs Participating in the New Horizons Advancing Paediatric HIV Care Collaborative. 2016. Presented at 21st International AIDS Conference; Durban, South Africa. 2016.
UNAIDS, 2023, Global HIV and AIDS statistics- Fact sheet. Available from: https://www.unaids.org/en/resources/fact-sheet#:~:text=Global%20HIV%20statistics,AIDS%2Drelated%20illnesses%20in%202023. Accessed on 21 May 2024.
Lee S, Hazra R. Achieving 90-90-90 in paediatric HIV: adolescence as the touchstone for transition success. J Int AIDS Soc. 2015;18:20257.
Siyan Y, Chanrith N, Khuondyla P, Vohith K, Sovannary T, Sokunmealiny S, et al. Transition into adult care: factors associated with level of preparedness among adolescents living with HIV in Cambodia. AIDS Res Ther. 2017;14:1-5.
Alice A, Jason MN, Marissa V, Cadi I, Lucie C, Annette HS, et al. A Global Research Agenda for Adolescents Living with HIV. J Acquired Immune Def Syndr. 2018;78:S16-21.
Scovia NM, Sabrina BK, Derrick AL, Philippa M, Mathew N, Dan KK. Transition to adult care: Exploring factors associated with transition readiness among adolescents and young people in adolescent ART clinics in Uganda. PloS One. 2021;16(4):e0249971.
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