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Transition Program of HIV-infected adolescents to Adult HIV care
in Buenos Aires, ArgentinaS. Arazi Caillaud1, D. Mecikovsky1,
A.Bordato1, J.Lattner2, L.Spadaccini2, C.Rodrguez3, R. Posada4,
P.Cahn2, R. Bologna1 1Hospital de Pediatra Dr J. P. Garrahan,
Buenos Aires, Argentina2Hospital Fernndez, Buenos Aires, Argentina3
Hospital Cosme Argerich, Buenos Aires, Argentina4 Mount Sinai
School of Medicine, New York, USAwww.aids2014.orgBackground With
advances in ARV therapy most HIV-infected children survive into
adulthood Optimal health care includes a formal plan for the
transition of care from primary pediatric care to adult health-care
providers Transitioning difficulties include changes of puberty,
factors related to HIV infection (disclosure, stigma, parental
loss, poor treatment adherence, poverty, sexual life), family
resistance, and limited training of health professionals
Scal P,. J Adolesc Health. 1999;24:259-264www.aids2014.org la
transferencia definida y programada de los adolescentes y adultos
jvenes con patologas crnicas desde un centro peditrico hacia un
centro orientado a la atencin mdica de adultos 2
ARGENTINABuenos AiresHospital de Pediatra Garrahan 507
HIV-infected children in follow-up Median age: 12 years
(0.3-21)Transition Program in Buenos Aires, Argentina Argentina has
a prevalence of 130,000 HIV cases, with 100 (70-120) children newly
infected per year Free access to HIV treatment (ART +
care)www.aids2014.orgTransition Program Pilot project: 2007 (cross-
sectional review)Transition program: 2008-2013Phase 1: Team
activities (local team, identification of potential adult-care
centers, development of guidelines, communication plan,
registry)Patient and family activities (Transition Clinic,
workshops, peer support groups): risk reduction, empowerment,
autonomy, how to navigate the new hospital ) Phase 2: Actual
transition to adult carePhase 3: Monitoring and Evaluation
www.aids2014.org
Pilot Study: Baseline characteristics (N:85)Median age, years
(IQR) 18.2(16.5-19.6)Sex N (%)females37(43.5)males48(56.5)Median
age at diagnosis years (IQR) 3.8(0.9-8.7)Duration of treatment,
years (IQR)14(8.8-15.6)HIV transmission category N (%)
Perinatal72(84.7) Transfusion 7(8.3) Others 6(7.0)CDC Category C
events N (%)54(63.5)www.aids2014.orgTransition Program Pilot
project: 2007 (cross- sectional review)Transition program:
2008-2013Phase 1: Team activities (local team, identification of
potential adult-care centers, development of guidelines,
communication plan, registry)Patient and family activities
(Transition Clinic, workshops, peer support groups): to provide
support and risk reduction counseling, help them to navigate the
new hospital Phase 2: Actual transition to adult carePhase 3:
Monitoring and Evaluation www.aids2014.orgWorkshops Peer support
groupsMultimedia sessions: Interactive activities Videos
Different means of communication (SMS, dropbox, telephone
calls)Transition clinic with more flexible appointments Medical and
social history was communicated to accepting provider by a
physician Guide to navigate the new hospital has been designed
www.aids2014.org
Welcome to the Infectious Diseases Unit
Prospective, observational study Setting: Hospital de Pediatra
Dr J.P.Garrahan Adult centers(receptors): Hospital Fernndez
Hospital Argerich Population: adolescents HIV infected as children
> 16 years enrolled at the pediatric hospital, and transferred
to adult health-care centers between 06/2007 and 12/2013 Aim of the
study: to evaluate the transition program Transition was considered
successful when at least 2 clinic visits and 1 viral load testing
took place at an adult-care center within 6 months after referral
Demographic, clinical, virological, and social characteristics of
adolescents at the time of transition were evaluated To evaluate
the contingency tables Fisher or Chi square Tests were used.
Materials and methodswww.aids2014.orgCharacteristics of 230 HIV
infected adolescents Age, median yrs (range)18(16-22)Sex N
(%)female117 (51)male113 (49)Transmission category N
(%)perinatal222 (96)transfusion 5 (3)Others 3 (1) Clinical stage N
(%)A29 (12.6)B54 (23.5)C133 (57.8)Immunological Stage N (%)133
(14.3)257 (23.9)3126 (65.9)Post-transition follow-up, median mos
(range)38(3 - 67)Laboratory tests done post-transition (median,
IQR)3(1 4)Last Viral Load < 50 copies/ml N, %145(62.9)Last CD4
count/ml Median (IQR)550(372-788)Results
www.aids2014.orgResults
Transitioned N=13072.3%www.aids2014.orgResultsVariables
associated with transition outcomeVariableRRCI 95%pSex0.470.40
1.500.44Age0.42Loss of one or both parents1.090.33 2.430.83Caring
for his/her own health0.340.19 0.631/week)189Substance use
(N:187)No 15383.2Yes3416.8Habits and social characteristics of
patients in transitionwww.aids2014.orgAcknowledgements We would
like to thankthe patients who participated in this program and
their families, all health care personnel Fogarty AITRP #5D43
TW001037
www.aids2014.org
