TY - JOUR
T1 - We never thought this would happen
T2 - Transitioning care of adolescents with perinatally acquired HIV infection from pediatrics to internal medicine
AU - Vijayan, Tara
AU - Benin, Andrea L.
AU - Wagner, Krystn
AU - Romano, Sostena
AU - Andiman, Warren A.
N1 - Funding Information:
We would like to thank Nancy Kim, MD, and Nora Groce, PhD for their thoughtful comments, and Anne Murphy and Leslie Hurst for their referrals of patients. We are grateful to the adolescents and their families who shared their experiences with us. Supported by the Doris Duke Clinical Research Fellowship. Supported in part by a grant from the NIH (T32-AI07210-23).
PY - 2009/10
Y1 - 2009/10
N2 - Purpose. Transitioning the medical care of children with perinatally acquired HIV from pediatric care to internal medicine practices has become increasingly important as newer therapies prolong survival. The study aims to describe challenges to caring for these adolescents and the potential barriers to transitioning them to internal medicine-based care. Methods. Qualitative study in which data were gathered from open-ended interviews conducted from November 2005 to April 2006 with 18 adolescents with HIV, 15 of their parents, and 9 pediatric health care providers from the Yale Pediatric AIDS Care Program, New Haven, Connecticut. Results. Issues of stigma played a prominent role in both the challenges to care and barriers to transitioning care. Challenges to care were: (1) poor adherence to medication regimens; (2) adolescent sexuality; and (3) disorganized social environments. Potential barriers to transitioning care were: (1) families' negative perceptions of and experiences with stigma of HIV disease - which undermined the desire to meet new providers; (2) perceived and actual lack of autonomy - pediatric providers feared that staff in adult clinics would demand a level of independence that adolescents did not have; and (3) difficulty letting go of relationships - adolescents, guardians, and providers described a familial relationship and expressed anxiety about terminating their relationships. Conclusion. Understanding these challenges and barriers can inform both pediatric and adult HIV care providers and enable them to create successful transition programs, with the goal of improving retention and follow-up to care.
AB - Purpose. Transitioning the medical care of children with perinatally acquired HIV from pediatric care to internal medicine practices has become increasingly important as newer therapies prolong survival. The study aims to describe challenges to caring for these adolescents and the potential barriers to transitioning them to internal medicine-based care. Methods. Qualitative study in which data were gathered from open-ended interviews conducted from November 2005 to April 2006 with 18 adolescents with HIV, 15 of their parents, and 9 pediatric health care providers from the Yale Pediatric AIDS Care Program, New Haven, Connecticut. Results. Issues of stigma played a prominent role in both the challenges to care and barriers to transitioning care. Challenges to care were: (1) poor adherence to medication regimens; (2) adolescent sexuality; and (3) disorganized social environments. Potential barriers to transitioning care were: (1) families' negative perceptions of and experiences with stigma of HIV disease - which undermined the desire to meet new providers; (2) perceived and actual lack of autonomy - pediatric providers feared that staff in adult clinics would demand a level of independence that adolescents did not have; and (3) difficulty letting go of relationships - adolescents, guardians, and providers described a familial relationship and expressed anxiety about terminating their relationships. Conclusion. Understanding these challenges and barriers can inform both pediatric and adult HIV care providers and enable them to create successful transition programs, with the goal of improving retention and follow-up to care.
KW - Adolescents
KW - HIV/AIDS
KW - Special health care needs
KW - Transition
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U2 - 10.1080/09540120902730054
DO - 10.1080/09540120902730054
M3 - Article
C2 - 20024697
AN - SCOPUS:70450194934
SN - 0954-0121
VL - 21
SP - 1222
EP - 1229
JO - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
JF - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
IS - 10
ER -