Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA.
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, USA.
J Int AIDS Soc. 2017 Sep 1;20(1):21848. doi: 10.7448/IAS.20.1.21848.
INTRODUCTION: The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. METHODS: We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. RESULTS: Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; = 0.002). CONCLUSIONS: Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year in the adult setting.
引言：从儿科到成人艾滋病护理的过渡时期是年轻人脱失率极高的时期；然而，目前缺乏相关实证数据。
方法：我们回顾了美国佐治亚州亚特兰大 Grady 传染病项目的儿科和成人诊所从 2004 年至 2014 年的 72 名青年患者的病历记录。我们从儿科诊所的最后两年和成人诊所的前两年提取了与衔接、保留和病毒学抑制相关的临床数据。
结果：在计划至少有一次成人诊所就诊的患者中，97%的患者最终由成人医生接诊（最后一次儿科就诊和首次成人就诊之间的中位数时间为 10 个月，四分位距为 2-18 个月）。一半的患者在过渡前立即接受儿科护理，而另一半患者在儿科护理期间出现空档，并作为成年人重新注册儿科诊所。在过渡后的第一年，共有 89%的患者（至少间隔三个月就诊两次）得到保留，第二年为 56%。在最后一次儿科就诊后三个月内到成人诊所就诊的患者，在过渡后病毒抑制的可能性大于就诊时间更长的患者（相对风险（RR）：1.76；95%置信区间（CI）：1.07-2.9；P=0.03）。在最后一次儿科就诊时病毒学得到抑制（检测不到的检测下限的 HIV-1 RNA）的患者，在最近一次成人就诊时也更有可能得到抑制（RR：2.3；95%CI：1.34-3.9；P=0.002）。
结论：在过渡到成人护理后，虽然最初的保留率很高，但在过渡后的第二年显著下降。在过渡前病毒学得到抑制和儿科与成人诊所之间的衔接时间较短与过渡后更好的结果相关。为了优化过渡，对于那些未达到病毒学控制的患者，以及在成人环境中度过第一年的青年患者，需要提供强化的过渡支持。
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