Kung Tiffany H, Wallace Melissa L, Snyder Kathryn L, Robson Victoria K, Mabud Tarub S, Kalombo Cathy D, Bekker Linda-Gail
Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, South Africa; School of Medicine, Stanford University, Stanford, CA, USA.
S Afr Med J. 2016 Jul 6;106(8):804-8. doi: 10.7196/SAMJ.2016.v106i8.10496.
The first generation of South African (SA) children perinatally infected with HIV is entering adulthood, and there is now a pressing need for systematised transfer of these patients from paediatric to adult care.
Previous research has investigated the HIV healthcare transition in North America and Europe, yet none has been conducted in SA. Our study is the first to describe the perspectives of healthcare providers overseeing the transition in resource-limited settings.
We approached healthcare providers working in government paediatric HIV clinics and hospitals in the Western Cape Province, SA. Seven physicians and counsellors in adolescent/paediatric care, representing five clinics, were interviewed, and 43 completed a written survey. Interviews addressed the current state of the transition, barriers and facilitators, and model components. Interviews were assessed for major themes using framework analysis, while logistic regression was applied to survey responses to identify associations with measured covariates.
Analysis of interview transcripts revealed several overarching perspectives that were corroborated by survey responses. One barrier identified was the healthcare providers' difficulty in letting go of their relationships with the adolescent patients. Since healthcare providers regarded their patients as particularly vulnerable, they felt a strong and protective attachment towards them. A second barrier identified was a lack of structure and effective communication between adult and paediatric providers; accordingly, healthcare providers feared that they were transferring their adolescents unprepared, to a judgemental, depersonalised and overburdened environment. All interviewees and a majority of survey respondents (>80%) agreed that the formation of adolescent support groups in adult care clinics as well as a later transition age would improve the transition process.
This study highlights the need for a systematic healthcare transition for HIV-positive adolescents cared for in the Western Cape, while acknowledging the limitations of the current healthcare infrastructure. Several feasible recommendations have been identified, including forming support groups and greater involvement of adolescent healthcare providers to facilitate the transition.
第一代南非围产期感染艾滋病毒的儿童正步入成年期，目前迫切需要将这些患者从儿科护理系统地转移到成人护理。
以往的研究调查了北美和欧洲的艾滋病毒医疗保健过渡情况，但南非尚未开展此类研究。我们的研究首次描述了在资源有限环境中监督过渡的医疗保健提供者的观点。
我们联系了在南非西开普省政府儿科艾滋病毒诊所和医院工作的医疗保健提供者。采访了来自五个诊所的七名青少年/儿科护理医生和顾问，并让43人完成了书面调查。访谈涉及过渡的现状、障碍和促进因素以及模式组成部分。使用框架分析评估访谈的主要主题，同时对调查回复应用逻辑回归以确定与测量协变量的关联。
对访谈记录的分析揭示了几个总体观点，这些观点得到了调查回复的证实。确定的一个障碍是医疗保健提供者难以割舍与青少年患者的关系。由于医疗保健提供者认为他们的患者特别脆弱，他们对患者有一种强烈的保护依恋之情。确定的第二个障碍是成人和儿科提供者之间缺乏结构和有效的沟通；因此，医疗保健提供者担心他们在没有准备的情况下将青少年转移到一个评判性、非个性化和负担过重的环境中。所有受访者和大多数调查受访者（>80%）都认为在成人护理诊所成立青少年支持小组以及提高过渡年龄将改善过渡过程。
本研究强调了为西开普省接受护理的艾滋病毒阳性青少年进行系统医疗保健过渡的必要性，同时承认当前医疗基础设施的局限性。已确定了若干可行的建议，包括成立支持小组以及让青少年医疗保健提供者更多地参与以促进过渡。
