Transitioning from Pediatric to Adult HIV Care in Kenya

从儿科到自主成人护理的过渡是一个脆弱的时期，许多青少年辍学 艾滋病治疗方案。与成人艾滋病毒感染死亡率下降的趋势相反， 在许多情况下，受感染青少年的死亡率正在上升，这突出表明需要 改善过渡期护理。标准化的转换工具，如美国的Got Transition模型， 旨在帮助儿童、看护者和提供者规划和执行跨各种 慢性疾病;这些工具是有效的，并在美国广泛使用。然而，过渡工具主要是 在艾滋病毒流行率高的环境中，没有经过测试，而且很少有系统的过渡方法， 在非洲使用。此外，只有在披露艾滋病毒感染情况的同时，才能实现有效的过渡，而披露艾滋病毒感染情况的时间可能会推迟 由于照顾者担心应对、内疚或无意中失去保密性。期护理 儿童艾滋病毒披露是补充性的紧迫优先事项，为青少年艾滋病毒感染者。 我们建议在肯尼亚使用Got Transition工具，我们以前在那里观察到低比率， 保持和披露青少年。我们将使用全国电子病历（KenyaEMR） 确定现有青少年治疗计划的成功过渡率，并确定 成功转型（目标1）。我们将对青少年、护理人员、医护人员和 政策制定者为适应Got过渡工具在肯尼亚的使用提供信息（目标2）。最后，我们将测试 组合干预包，包括经过调整的过渡工具和之前经过验证的披露 在一个集群随机试验中的工具（目标3）。 该提案建立在华盛顿大学、 内罗毕大学和肯尼亚国家艾滋病/性传播感染控制方案。我们与 NASCOP使我们能够进行有影响力的，与当地相关的研究，并与国家 以方案方式促进大规模实施。调整已建立的Got Transition模型 在肯尼亚使用，并将其与披露工具包相结合，是解决 从儿科到成人艾滋病护理之间的连续性，预计将产生一种新的产品， 在全国实施。这项研究还将为一个可推广的 这是一项旨在改善整个非洲感染艾滋病毒的青少年的披露和过渡的方法。

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.