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Comparative Study
. 2020 Oct 27;15(10):e0240918.
doi: 10.1371/journal.pone.0240918. eCollection 2020.

Transition from pediatric to adult care for adolescents living with HIV in South Africa: A natural experiment and survival analysis

Brian C Zanoni  1   2   3 , Moherndran Archary  4 , Thobekile Sibaya  4 , Nicholas Musinguzi  5 , Jessica E Haberer  2   3
Affiliations
Comparative Study

Transition from pediatric to adult care for adolescents living with HIV in South Africa: A natural experiment and survival analysis

Brian C Zanoni et al. PLoS One. .

Abstract

Objective: To determine rates of retention and viral suppression among adolescents living with perinatally-acquired HIV who remained in pediatric care compared to those who transitioned to adult care.

Methods: We evaluated a natural experiment involving adolescents living with perinatally-acquired HIV who were attending a government-supported antiretroviral clinic in KwaZulu-Natal, South Africa. Prior to 2011, all adolescents transitioned to adult care at 12 years of age. Due to a policy change, all adolescents were retained in pediatric care after 2011. We analyzed adolescents two years before and two years after this policy change. Outcomes were retention in care and HIV viral suppression one year after transition to adult care or the 13th birthday if remaining in pediatric care.

Results: In the natural experiment, 180 adolescents who turned 12 years old between 2011 and 2014 were evaluated; 35 (20%) transitioned to adult care under the old policy and 145 (80%) remained in pediatric care under the new policy. Adolescents who transitioned to the adult clinic had lower rates of retention in care (49%; 17/35) compared to adolescents remaining in the pediatric clinic (92%; 134/145; p<0.001). Retention in care was lower (ARR 0.59; 95%CI 0.43-0.82; p = 0.001) and viral suppression was similar (ARR = 1.06, 95%CI 0.89-1.26; p = 0.53) for adolescents who transitioned to adult care compared to adolescents remaining in pediatric care.

Conclusion: Adolescents living with perinatally-acquired HIV appear to have higher retention in care when cared for in pediatric clinics compared to adult clinics. Longer-term follow-up is needed to fully assess viral suppression.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of outcomes among adolescent living with HIV who initiated ART in the pediatric clinic of Mahatma Gandhi Memorial Hospital.
Fig 2
Fig 2. Kaplan-Meier estimate for time to disengagement in care among adolescents living with perinatal HIV in pediatric or adult care.
See this image and copyright information in PMC

References

    1. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372(9635):293–9. Epub 2008/07/29. 10.1016/S0140-6736(08)61113-7 - DOI - PMC - PubMed
    1. Zanoni BA M; Buchan S; Katz I; Haberer J. Systematic Review and Meta-analysis of the Adolescent and Young Adult HIV Continuum of Care in South Africa: The Cresting Wave. BMJ Global Health. 2016;(1 (3) e000004; 10.1136/bmjgh-2015-000004 - DOI - PMC - PubMed
    1. Statistics South Africa. Recorded Live Births: 2013. In: Statistics South Africa, editor. Pretoria, South Africa 2013.
    1. South Africa National Department of Health. The 2012 National Antenatal Sentinel HIV and Herpes Simplex type-2 prevalence Survey. In: South Africa National Department of Health editor. Pretoria, South Africa2012.
    1. Sherman GG, Lilian RR, Bhardwaj S, Candy S, Barron P. Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa. S Afr Med J. 2014;104(3 Suppl 1):235–8. 10.7196/samj.7598 . - DOI - PubMed

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