Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina.
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York.
J Adolesc Health. 2017 Oct;61(4):434-439. doi: 10.1016/j.jadohealth.2017.05.011. Epub 2017 Jul 25.
The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during health care transition from adolescent- to adult-centered HIV care. HIV-related health care transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers' perspectives.
We examined health care transition processes through semi-structured interviews with 28 adult clinic staff across Adolescent Trials Network sites. We also collected quantitative data related to clinical characteristics and transition-specific strategies.
Overall, participants described health care transition as a "warm handoff" and a collaborative effort across adolescent and adult clinics. Emergent transition themes included adult clinical care culture (e.g., patient responsibility), strategies for connecting youth to adult care (e.g., adolescent clinic staff attending youth's first appointment at adult clinic), and approaches to evaluating transition outcomes (e.g., data sharing). Participants provided transition improvement recommendations (e.g., formalized protocols).
Using evidence-based research and a quality improvement framework to inform comprehensive and streamlined transition protocols can help enhance the capacity of adult clinics to collaborate with adolescent clinics to provide coordinated and uninterrupted HIV-related care and to improve continuum of care outcomes.
艾滋病毒护理连续统一体强调了需要对感染艾滋病毒的青年进行检测，并将其联系起来，使他们终生接受护理。为了使感染艾滋病毒的青年保持健康，保持低病毒载量并减少进一步传播，他们需要参与护理。护理连续统一体中的一个潜在中断点是从青少年为中心的艾滋病毒护理向成人为中心的艾滋病毒护理进行医疗过渡。与艾滋病毒相关的医疗过渡研究主要集中在青年和青少年诊所提供者上；而忽略了成人诊所提供者的观点。
我们通过对 28 名跨青少年试验网络地点的成人诊所工作人员进行半结构化访谈，研究了医疗过渡过程。我们还收集了与临床特征和特定过渡策略相关的定量数据。
总体而言，参与者将医疗过渡描述为“温暖交接”，是青少年和成人诊所之间的协作努力。出现的过渡主题包括成人临床护理文化（例如，患者责任），将青年与成人护理联系起来的策略（例如，青少年诊所工作人员参加青年在成人诊所的首次预约），以及评估过渡结果的方法（例如，数据共享）。参与者提供了过渡改进建议（例如，制定正式协议）。
使用循证研究和质量改进框架为全面和简化的过渡协议提供信息，可以帮助增强成人诊所与青少年诊所合作提供协调和不间断的艾滋病毒相关护理的能力，并改善护理连续统一体的结果。
