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Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: Using adolescent and adult providers’ insights to create multi-level solutions to address transition barriers

机译：在美国的14家诊所中将感染了HIV的青少年过渡到成人护理：利用青少年和成人提供者的见识创建解决过渡障碍的多层次解决方案

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HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n=28) and 20 adult clinics that receive transitioning adolescents (n=30) from August 2015 – June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents’ transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers’ ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.
机译：感染了HIV的青少年的护理保留率和病毒抑制率极低。过渡到成人诊所时，约有一半脱离护理，部分原因是护理系统分散，缺少简化的流程。从2015年8月至2016年6月，我们对14家青少年试验网络诊所（n = 28）和20家接受过渡青少年服务的成人诊所（n = 30）进行了58次社会服务和卫生保健提供者的质性访谈。检查成人照护过渡的过程，障碍和促进者。过渡壁垒在三个层次上融合在一起。结构性：保险资格，运输和与艾滋病相关的污名；临床：诊所间的交流，护理文化的差异以及资源/人员的局限性；和个人：青少年的过渡准备和发展能力。员工发起的解决方案（例如由赠款资助的运输）通常是不可持续的，并将个人级别的解决方案应用于结构级别的障碍。迫切需要采取综合措施，制定协作策略和协议，以支持提供商匹配解决方案和障碍级别（即结构到结构）的能力。这些举措还应支持本地系统规划，以促进跨部门的结构和沟通。这种方法将帮助感染艾滋病毒的青少年过渡到成人护理，并改善长期健康状况。

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