Abstract
BackgroundPreparing adolescents for transition into adult care and supporting their acquisition of self-health care management skills is a critical determinant of their post-transition HIV care outcomes. However, there is a scarcity of research on effective transition strategies. This study explores factors associated with adolescent preparedness for transition into adult care in Cambodia.MethodsIn August 2016, a cross-sectional study was conducted among 223 adolescents living with HIV aged 15–17, randomly selected from 11 antiretroviral therapy clinics, utilizing a structured questionnaire. The level of preparedness was determined using a pre-existing scale, and adolescents were categorized as having a high- or low level of preparedness for transition. Bivariate and multivariate analyses were conducted.ResultsOf 223 adolescents, 55.2% were male, and their mean age was 15.8 years. Overall, 53.3% had a high level of preparedness for transition. As part of the transition protocol, 2.7% had completed a transfer form, 24.7% had a transition case manager, 29.6% had been counselled about the transition, and 19.7% had visited an adult ART clinic. In multivariate analysis, a higher level of preparedness for transition was independently associated with older age (AOR 2.44, 95% CI 1.34–4.46; p = 0.004), family having received social support for their health (AOR 5.32, 95% CI 1.97–14.36; p = 0.001), knowing the kind of treatment they received (ART) (AOR 12.67, 95% CI 2.91–15.19; p = 0.001), trust in friends or family for HIV treatment (AOR 7.82, 95% CI 1.13–8.89; p = 0.008), receiving counseling on transition (AOR 3.17, 95% CI 1.15–8.76; p = 0.03), having a ‘Case Manager’ identified to support them during the preparation process for transition (AOR 3.89, 95% CI 1.08–13.96; p = 0.04), and satisfaction with preparation process for transition in general (AOR 0.35, 95% CI 0.03–0.87; p = 0.01).ConclusionsA range of individual, social and health system and services factors may determine successful transition preparedness among adolescents in Cambodia. Strengthening implementation of age-appropriate and individualized case management transition at all sites, while creating supportive family, peer, and healthcare environments for adolescent transition is required.
Highlights
Preparing adolescents for transition into adult care and supporting their acquisition of self-health care management skills is a critical determinant of their post-transition human immunodeficiency virus infection (HIV) care outcomes
Selection of study sites and participants In Cambodia, 90% of adolescents living with HIV access services from 18 clinics, while the remaining 10% are distributed across 21 sites, each with less than 10 adolescents living HIV clients
About one-fifth (22.0%) were working for pay, and 48.4% came from families that received social support for their health care, in the form of food support (78.7%), school allowance (64.8%), transport allowance for going to antiretroviral therapy (ART) clinic (55.6%), emotional counseling (32.4%), vocational training (25.9%), or home visit (10.2%)
Summary
Preparing adolescents for transition into adult care and supporting their acquisition of self-health care management skills is a critical determinant of their post-transition HIV care outcomes. This study explores factors associated with adolescent preparedness for transition into adult care in Cambodia. Adolescents and young people represent a growing share of people living with human immunodeficiency. Data on adolescents living with HIV are limited globally [6], concerns have emerged regarding their HIV-related clinical outcomes. While the overall mortality among people living with HIV in all other age groups had decreased by 32% during the period between 2005 and 2012, the overall mortality of adolescents living with HIV increased by 50% from 71,000 in 2005 to 110,000 in 2012 [6]. Adolescents are the only age group in which HIV-related mortality is rising [7]
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