Transitioning from Pediatric to Adult HIV Care in Kenya

从儿科向自主成人护理过渡是许多青少年辍学的脆弱时期 艾滋病治疗项目。与死亡率下降的成人艾滋病毒感染趋势相反， 在许多情况下，受感染青少年的死亡率正在上升，这突出表明有必要 改善过渡期护理。标准化的过渡工具，如美国的GET过渡模型，具有 旨在帮助儿童、照顾者和提供者规划和执行跨不同领域的过渡 慢性病；这些工具很有效，在美国被广泛使用。然而，过渡工具在很大程度上 在艾滋病毒高流行率的环境中未经测试，而且几乎没有系统的方法来过渡 在非洲使用。此外，只有在披露艾滋病毒的同时才能实现有效的过渡，而艾滋病毒的披露可能会被推迟 由于照顾者担心应对、内疚或无意中失去保密性。过渡期护理和 儿童艾滋病毒披露是艾滋病毒携带者青少年的补充紧急优先事项。 我们建议将GOT过渡工具调整为在肯尼亚使用，此前我们观察到肯尼亚的GET过渡工具 青少年的保留和披露。我们将利用全国电子病历(KenyaEMR) 确定现有青少年治疗方案的成功转换率，并确定 成功过渡(目标1)。我们将与青少年、照顾者、医护人员和 向政策制定者通报在肯尼亚使用GOT过渡工具的情况(目标2)。最后，我们将测试一个 组合干预方案，包括经过调整的过渡工具和先前已验证的披露 整群随机试验中的工具(目标3)。 这项提议是建立在华盛顿大学和华盛顿大学之间长达25年的艾滋病毒研究合作的基础上的。 内罗毕大学和肯尼亚国家艾滋病/性传播感染控制方案(NASCP)。我们与您的合作 NASCOP使我们能够进行有影响力的、与当地相关的、与国家保持一致的研究 促进大规模实施的方案办法。采用已建立的GOT过渡模型 在肯尼亚使用，并将其与披露工具包相结合是解决 从儿童到成人艾滋病毒护理的连续统一体，预计将产生一种新的产品，可以 在全国范围内实施。此外，这项研究还将为可推广的 改进整个非洲艾滋病毒感染青少年的信息披露和过渡的方法。

Transitioning from pediatric to autonomous adult care is a vulnerable period when many adolescents drop out of HIV treatment programs. In contrast to trends in adult HIV infection where mortality is decreasing, rates of mortality among infected adolescents are increasing in many settings, underscoring the need for improved transitional care. Standardized transition tools, such as the US-based Got Transition model, have been developed to help children, caregivers, and providers plan for and execute transition across diverse chronic diseases; these tools are effective, and widely utilized in the US. However, transition tools are largely untested in settings with high HIV prevalence, and there are few systematic approaches to transition being used in Africa. Furthermore, effective transition can only occur alongside HIV disclosure, which can be delayed due to caregiver concerns about coping, guilt, or inadvertent loss of confidentiality. Transitional care and pediatric HIV disclosure are complementary urgent priorities for adolescents with HIV. We propose to adapt the Got Transition tool for use in Kenya where we have previously observed low rates of retention and disclosure among adolescents. We will utilize nationwide electronic medical records (KenyaEMR) to determine rates of successful transition in existing youth treatment programs, and determine predictors of successful transition (Aim 1). We will conduct interviews with adolescents, caregivers, healthcare workers and policy-makers to inform adaptation of the Got Transition tool for use in Kenya (Aim 2). Finally, we will test a combined intervention package consisting of the adapted transition tool plus a previously validated disclosure tool in a cluster randomized trial (Aim 3). This proposal builds on a >25 year HIV research collaboration between the University of Washington, the University of Nairobi, and the Kenya National AIDS/STI Control Programme (NASCP). Our collaboration with NASCOP enables us to conduct research that is impactful, locally relevant, and aligned with national programmatic approaches to facilitate implementation at scale. Adapting the established Got Transition model for use in Kenya and combining this with the disclosure toolkit is an efficient approach to address the continuum between pediatric to adult HIV care, and is expected to result in a novel product that can be implemented nationally. The study will additionally provide important evidence for a generalizable approach to improve disclosure and transition for adolescents with HIV infection throughout Africa.