SAN FRANCISCO — There are numerous barriers that reduce the likelihood that youth with HIV will transition from pediatric care to adult care, according to a study conducted at a Detroit HIV clinic. Researchers said that pediatric social workers — a familiar presence in some patients’ lives — are more likely than adult medical staff to discover the reasons why patients cannot successfully transition to adult care.
“Caring for adolescents is a multidisciplinary task,” Rynita Bohler, from Wayne State University, told Infectious Diseases in Children. “Social workers are important parts of the team, and their continued collaboration during the transition period — until the adolescent feels comfortable and learns to trust the adult group — is extremely important.”
To identify barriers to care during this transition, adult providers and a pediatric social worker screened people who were not able to attend three appointments at an adult HIV clinic. Patients were asked to identify their reasons for not attending.
The researchers identified 104 youths who required transition from pediatric to adult care. Nearly one-third (30.7%) were not able to successfully transition and attend the three appointments. According to Bohler and colleagues, 18% of these patients could be reached with a phone call or text message.
The most frequently reported reasons for not successfully transitioning to adult care included transportation (n = 10) and work (n = 4). Among those who did not transition to adult care, there were no significant variances regarding patients’ race, how they were infected, housing status or employment status.
When adult medical staff questioned patients about their unsuccessful transition, eight reasons were provided compared with 13 reasons when asked by a pediatric social worker: work (12%); transportation (11%); relocation, which resulted in exclusion from the study (9%); no phone access (9%); difficulty dealing with diagnosis (9%); no reported problems (9%); lost insurance (3%); mental health (3%); incarceration (3%); went to a drug treatment facility (3%); family issues (3%); and domestic violence (3%).
All other responses (23%) were listed under an “other” category as the 13th response.
Bohler and colleagues suspected that adolescents gave the social worker more reasons for failing to transition to adult care because they had established a more trusting relationship with the social worker and were more forthcoming as a result
“I believe our findings are applicable to other urban centers. Regardless of location, there continues to be issues with transitioning adolescents with HIV [to adult care],” Bohler said. “This indicates that further investigation into the emotional needs of transitioning adolescents and continued involvement with the social worker are warranted to improve transition of care.” – by Katherine Bortz
Bohler R, et al. Abstract 577. Presented at: IDWeek 2018; October 3-7, 2018; San Francisco.
Disclosures: Bohler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.