577. Barriers to Transitions of Care in the Detroit Young HIV Population

Abstract

BackgroundOne of the issues faced by clinics which care for young adults infected with HIV is a disruption to treatment during the transition from pediatric to adult care. Adherence to routine treatment is essential for this population to ensure decreased rates of transmission and favorable health outcomes for the patients. The purpose of this study was to characterize the out of care transitioning patient population from pediatric to adult HIV care in an academic HIV clinic in Detroit, Michigan.MethodsWe assessed barriers to transition for youth with HIV who had not met the requirements for successful transition to the adult HIV clinic (three appointments). Patient barriers were assessed through telephone calls with three questions assessing their reasons for not coming to the adult clinic conducted by adult medical staff and by a pediatric social worker.ResultsOne hundred and four youth were identified as transitioning youth. Of those, 13 were excluded due to relocation. Thirty-two (30.7%) patients did not successfully transition and 19 (18%) were accessible through telephone/text for interview. Demographic data for the 32 patients was collected and the predictors of disengagement were identified which included transportation (22.2, n = 10) and work (8.9%, n = 4). There were no statistically significant differences in the measured variables of race, HIV mode of acquisition, housing status, or employment status between those who did and did not successfully transition. In regards to reasons for missed appointments, there were eight reasons given to the adult medical staff, but the pediatric social worker was able to elicit, a much broader range of answers, 13.ConclusionWe found that lack of phone access, transportation and work play a key role in patients transitioning to the adult clinic; however, we initially expected more socioeconomic factors to impair the transition process. In looking at the mismatched reasons for missed appointments given to the adult clinic and the pediatric social worker, it appears that the pediatric social worker could elicit a greater the variety of reasons for missed appointments. Moving forward, more pediatric social work support for the transitioning process may be beneficial.Figure 1. Reasons for Missed Appointments Given to Pediatric Social Worker. Disclosures J. Veltman, Jansen: Speaker’s Bureau, Speaker Bureau payment.