Tsondai Priscilla R, Davies Mary-Ann, Singtoroj Thida, Maxwell Nicola, Technau Karl-Günter, Chokephaibulkit Kulkanya, Lumbiganon Pagakrong, Sohn Annette H
Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand.
PLOS Glob Public Health. 2024 Aug 5;4(8):e0002705. doi: 10.1371/journal.pgph.0002705. eCollection 2024.
Few national programs and research cohorts within low- and middle-income countries (LMICs) document transition-related processes and outcomes for adolescents and young adults living with HIV (AYLH) transitioning to adulthood. Between 2017-2020, The Global fRAmework of Data collection Used for Adolescent HIV Transition Evaluation (GRADUATE) project convened a collaborative advisory group to identify key variables and definitions capturing the process, predictors, and outcomes across the transition period. In total, 114 variables identified as essential to measuring AYLH transition-related data were identified and formatted into a GRADUATE Data Exchange Standard (DES), which was added to and harmonized with the existing International epidemiology Databases to Evaluate AIDS (IeDEA) DES. In 2019, the GRADUATE DES was pilot tested at four IeDEA facilities in Malawi, South Africa, and Thailand through a cross-sectional study. Upon comparing the variables to routine medical records, available data were too limited to adequately capture transition-related processes and outcomes. However, additional data collection using GRADUATE tools was feasible and improved completeness. Of the 100 (52% female) AYLH included in the pilot study, 71% had transitioned/transferred to adult care, with 42% transitioning from an adolescent-specific model of care within an integrated family clinic to having their clinic visits scheduled on a different day of the week while 58% transferred from a pediatric facility to one offering adult HIV care. While almost all (94%) had a transition-related discussion with their healthcare providers prior to the transition, we found that 69% (95% CI 49-85%) were somewhat or very satisfied/comfortable with the post-transfer clinic and the staff. Utilization of the GRADUATE DES better characterized AYLH transitioning to adulthood across LMICs, and optimally measured transition preparation activities and outcomes. Utilization of the GRADUATE DES in other settings could facilitate comparisons and identify gaps in the care of transitioning adolescents that need to be addressed.
在低收入和中等收入国家（LMIC）中，很少有国家项目和研究队列记录感染艾滋病毒的青少年和青年（AYLH）向成年过渡的相关过程和结果。2017年至2020年期间，用于青少年艾滋病毒过渡评估的数据收集全球框架（GRADUATE）项目召集了一个合作咨询小组，以确定在整个过渡期间捕捉过程、预测因素和结果的关键变量及定义。总共确定了114个被认为对测量AYLH过渡相关数据至关重要的变量，并将其整理成GRADUATE数据交换标准（DES），该标准已添加到现有的国际艾滋病流行病学数据库评估（IeDEA）DES中并与之协调统一。2019年，通过一项横断面研究在马拉维、南非和泰国的四个IeDEA机构对GRADUATE DES进行了试点测试。在将这些变量与常规医疗记录进行比较时，可用数据过于有限，无法充分捕捉与过渡相关的过程和结果。然而，使用GRADUATE工具进行额外的数据收集是可行的，并且提高了完整性。在纳入试点研究的100名（52%为女性）AYLH中，71%已过渡/转诊至成人护理，其中42%从综合家庭诊所内的青少年特定护理模式过渡到在一周的不同日期安排门诊就诊，而58%从儿科机构转诊至提供成人艾滋病毒护理的机构。虽然几乎所有（94%）在过渡前都与医疗服务提供者进行了与过渡相关的讨论，但我们发现69%（95%置信区间49 - 85%）对转诊后的诊所和工作人员 somewhat或非常满意/放心。GRADUATE DES的使用更好地描述了LMIC中向成年过渡的AYLH情况，并最佳地衡量了过渡准备活动和结果。在其他环境中使用GRADUATE DES可以促进比较，并识别在过渡青少年护理方面需要解决的差距。 （注：“somewhat”此处暂未准确译出合适中文，保留英文供参考）
Cochrane Database Syst Rev. 2022-2-1
2017-11-3
Front Glob Womens Health. 2021-10-25
J Biomed Inform. 2019-5-9
Zotero 插件