Transitioning HIV+ Adolescents to Adult Care: Exploring Adolescent and Adult Medicine Clinics Role in the Process
- Conditions
- HIV
- Registration Number
- NCT02785302
- Lead Sponsor
- University of North Carolina, Chapel Hill
- Brief Summary
This is a multi-site, longitudinal study and it describes the transition process of behaviorally-infected HIV-positive youth as they move from pediatric- and adolescent-specific care to adult care. To achieve this goal, the transition process is characterized from the perspectives of HIV-positive youth, Adolescent Medicine Trials Unit (AMTU) clinic staff, and receiving adult clinic staff.
- Detailed Description
The changes associated with transition to adult clinical care may increase the likelihood that an adolescent will drop out of care, which results in poorer outcomes. Disengagement from care has implications for health. Disruption in medication can increase viral load (VL), and intensify the potential for co-morbidities and transmission efficiency . Thus, successful transition to adult care is especially important for HIV-positive adolescents (compared to other chronic diseases) as they will need to maintain clinic visits and medication adherence across their lifespan to remain healthy and maintain a low VL to reduce the potential for transmission in the context of other developmental and psychosocial changes and challenges. The ultimate goal of this study is to represent the key places - youth, adolescent clinic and adult clinic - where transition interventions could be targeted and to collect data to capture the key elements and modifiable variables at each level. This study will contribute to existing research by providing transition research on HIV, which differs from other congenital or acquired chronic conditions due to it being an infectious disease; by prospectively following youth as they transition; and by providing transition research from the perspective of receiving adult clinics. It will also illustrate how each level- youth, adolescent clinic and adult clinic - is situated within a specific context and how these levels interact to affect transition outcomes.
This is a multi-method, longitudinal design research study. Subjects must be enrolled in ATN 125 at the time of the ATN 135 baseline visit. There will be no randomization procedures. During the 39-week study, surveys will be administered to adolescents and young adults transitioning to adult care via Audio Computer Assisted Self Interviews (ACASIs), which will collect data on individual (e.g., psychosocial and behavioral) and clinical factors affecting transition at 0 and 39 weeks. Demographic, biomedical, antiretroviral therapy (ART) and healthcare utilization visit information collected through ATN 125 medical chart abstraction will also become part of the ATN 135 subject dataset. One-time phone surveys and interviews with AMTU and adult clinic staff will also be conducted to collect information on transition protocols as well as review of any documentation of existing transition protocols (e.g., transitioning SOP). Outcome measures will include pre- and post-transition VL and other measures of physical and psychosocial health status to compare individuals with different patterns and outcomes of transition.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 136
Not provided
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Transition Expectations and Experiences as assessed by the ACASI (comparison between pre- and post-transition) 39 weeks Patterns of Transition as assessed by the ACASI, as well as medical and appointment records abstraction (comparison between pre- and post-transition) 39 weeks Patterns of Engagement in Care as assessed by the ACASI, as well as medical and appointment records abstraction (assessment over time from point of transition) 39 weeks
- Secondary Outcome Measures
Name Time Method Preparedness of Adult Clinics to Receive Behaviorally-Infected HIV-Positive Youth Transitioning from Adolescent Clinics 1 day Preparedness will be assessed by one-time interviews with Adult Clinic staff where youth from AMTUs transition their care within one year of site registration.
Transition Protocols at AMTUs and Adult Clinics 1 day Transition protocols will be assessed by one-time interviews with AMTU Clinic staff where youth from AMTUs transition their care within one year of site registration.
Transition Processes at AMTUs and Adult Clinics 1 day Transition processes will be assessed by one-time interviews with AMTU Clinic staff where youth from AMTUs transition their care within one year of site registration.
Trial Locations
- Locations (14)
Childrens Hospital of Los Angeles
๐บ๐ธLos Angeles, California, United States
Stroger Hospital of Cook County
๐บ๐ธChicago, Illinois, United States
Johns Hopkins University
๐บ๐ธBaltimore, Maryland, United States
Children's Hopsital of Philadelphia
๐บ๐ธPhiladelphia, Pennsylvania, United States
St. Jude Children's Research Hospital
๐บ๐ธMemphis, Tennessee, United States
Children's Hosp Natinal Med Center
๐บ๐ธWashington, District of Columbia, United States
University of Colorado - The Children's Hospital of Denver
๐บ๐ธAurora, Colorado, United States
Tulane Medical Center
๐บ๐ธNew Orleans, Louisiana, United States
Fenway Institute
๐บ๐ธBoston, Massachusetts, United States
Wayne State University
๐บ๐ธDetroit, Michigan, United States
University of Miami
๐บ๐ธMiami, Florida, United States
University of South Florida
๐บ๐ธTampa, Florida, United States
Baylor College of Medicine
๐บ๐ธHouston, Texas, United States
Montefiore Medical Center
๐บ๐ธBronx, New York, United States