Tepper Vicki, Zaner Stefanie, Ryscavage Patrick
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
J Int AIDS Soc. 2017 May 16;20(Suppl 3):21490. doi: 10.7448/IAS.20.4.21490.
The transition from paediatric to adult care poses risks to the health of young adults living with HIV if unsuccessful, including interruptions in care and poor health outcomes. Evolving best practices in HIV healthcare transition should ideally be informed by real-world qualitative and quantitative clinical healthcare transition outcomes. There has been a recent proliferation of HIV healthcare transition outcome research, largely from Europe and North America.
A literature search was undertaken using the online databases PubMed, Web of Science, and Google Scholar. Medical subject and text word searches were combined for terms relating to HIV, paediatric transition outcomes, and internal and external factors were used to identify peer-reviewed articles.
In this paper, we review data on HIV healthcare transition outcomes in North America and Europe. Internal and external factors which may impact the success of HIV healthcare transition are examined. We describe ongoing research efforts to capture transition outcomes in the North America and Europe. Clinical, operational, and implementation science research gaps that exist to date are highlighted. Efforts to improve HIV healthcare transition research through country-level surveillance networks and large multicentre cohorts, including data integration and linkage between paediatric and adult cohorts are discussed.
We identified the need for a comprehensive approach to implementing empirically supported protocols to support healthcare transition for ALHIV. While there is limited prospective longitudinal cohort data available at this time, cohorts linking the paediatric and adolescent with ongoing surveillance into adulthood are being developed. Through a review of existing qualitative and quantitative healthcare transition outcomes studies, we identify emerging areas of consensus surrounding healthcare transition research implementation. Successful healthcare transition programmes in Europe and North America often share several characteristics, including implementation of a youth friendly multidisciplinary approach, consistent communication and integration between paediatric and adult care teams, and an individualized approach which is attuned the adolescent's transition readiness. Moving forward, the voices of youth and young adults living with HIV should be included in the development and evaluation of healthcare transition protocols to ensure that the definition of successful transition reflects all of the stakeholders in the transition process.
如果从儿科护理过渡到成人护理的过程不成功，会对感染艾滋病毒的年轻人的健康构成风险，包括护理中断和不良健康结果。理想情况下，不断发展的艾滋病毒医疗保健过渡最佳实践应以实际的定性和定量临床医疗保健过渡结果为依据。最近，艾滋病毒医疗保健过渡结果研究大量涌现，主要来自欧洲和北美。
使用在线数据库PubMed、Web of Science和谷歌学术进行文献检索。将医学主题词和文本词搜索相结合，搜索与艾滋病毒、儿科过渡结果相关的术语，并使用内部和外部因素来识别同行评审文章。
在本文中，我们回顾了北美和欧洲艾滋病毒医疗保健过渡结果的数据。研究了可能影响艾滋病毒医疗保健过渡成功的内部和外部因素。我们描述了在北美和欧洲为获取过渡结果而正在进行的研究工作。强调了迄今为止存在的临床、操作和实施科学研究差距。讨论了通过国家层面的监测网络和大型多中心队列来改善艾滋病毒医疗保健过渡研究的努力，包括儿科和成人队列之间的数据整合和关联。
我们确定需要一种全面的方法来实施有实证支持的方案，以支持感染艾滋病毒的青少年和年轻人的医疗保健过渡。虽然目前可用的前瞻性纵向队列数据有限，但正在建立将儿科和青少年与成年期持续监测联系起来的队列。通过回顾现有的定性和定量医疗保健过渡结果研究，我们确定了围绕医疗保健过渡研究实施的新出现的共识领域。欧洲和北美的成功医疗保健过渡计划通常具有几个共同特征，包括实施对青年友好的多学科方法、儿科和成人护理团队之间持续的沟通与整合，以及一种根据青少年的过渡准备情况进行调整的个性化方法。展望未来，感染艾滋病毒的青年和年轻人的声音应纳入医疗保健过渡方案的制定和评估中，以确保成功过渡的定义反映过渡过程中的所有利益相关者。
