Diane M. Straub

Transition of Adolescents With HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions

&NA; The transition process from pediatric to adult health care for adolescents with chronic diseases is always challenging and can be even more so for adolescents with HIV disease. The purpose of this study was to describe characteristics and current practices surrounding the transition of adolescents from the clinics of the Adolescent Trials Network for HIV/AIDS Interventions to adult medical care. This report focuses on the processes of transition, perceived barriers and facilitators, and anecdotal reports of successes and failures. Practice models used to assist adolescents during transition to adult medical care are described. Interviews were conducted with 19 key informants from 14 Adolescent Trials Network clinics. Findings revealed no consistent definition of “successful” transition, little consensus among the sites regarding specific elements of a transition program, and a lack of mechanisms to assess outcomes. Sites that viewed transition as a process rather than an event consistently described more structured program elements.

Prevention With Positives: A Review of Published Research, 1998-2008

&NA; HIV prevention education and counseling efforts have historically been directed toward those individuals considered at risk for exposure to HIV and assumed to be uninfected with HIV. In the late 1990s, prevention efforts began to include individuals who were HIV‐infected. In 2003, the Centers for Disease Control and Prevention recommended that HIV prevention be incorporated into the medical care of persons living with HIV. This domain of HIV prevention work is known as prevention with positives or positive prevention, and research within this domain has been ongoing for a decade. This article provides a review of the scientific evidence within the prevention with positives domain from 1998 to 2008. A discussion is provided regarding early descriptive and formative studies as well as more recent and ongoing intervention trials specifically designed for persons living with HIV. A summary of current knowledge, a description of ongoing research, and gaps in knowledge are identified. Topics for future research are suggested.

MOBILIzINg COMMUNITIES AROUND HIV PREVENTION FOR YOUTH: HOW THREE COALITIONS APPLIED KEY STRATEgIES TO BRINg ABOUT STRUCTURAL CHANgES

Increasingly, HIV prevention efforts must focus on altering features of the social and physical environment to reduce risks associated with HIV acquisition and transmission. Community coalitions provide a vehicle for bringing about sustainable structural changes. This article shares lessons and key strategies regarding how three community coalitions located in Miami and Tampa, Florida, and San Juan, Puerto Rico engaged their respective communities in bringing about structural changes affecting policies, practices and programs related to HIV prevention for 12-24-year-olds. Outcomes of this work include increased access to HIV testing and counseling in the juvenile correctional system (Miami), increased monitoring of sexual abuse between young women and older men within public housing, and support services to deter age discordant relationships (Tampa) and increased access to community-based HIV testing (San Juan).

Expedited Partner Therapy for Adolescents Diagnosed with Chlamydia or Gonorrhea: A Position Paper of the Society for Adolescent Medicine

Chlamydia and gonorrhea, the most frequently reported sexually transmitted infections (STIs), present substantial public health challenges among adolescents. Although these infections are easily treated with antibiotics, many adolescents are reinfected within 3–6 months, usually because their partners remain untreated. The standard approaches to notifying and treating a partner of an STI-infected patient are patient referral, whereby the patient notifies his/her partners to seek care, and provider referral, whereby the provider or public health disease intervention specialist notifies the partner and directs him/her toward treatment. These methods rely on the accuracy of the disclosed partner information as well as other limitations, such as compliance and staffing resources. Another approach to partner notification is expedited partner therapy (EPT), treating sex partners without requiring a prior clinical evaluation. In randomized trials, EPT has reduced the rates of persistent or recurrent gonorrhea and chlamydia infection; however, its routine use is limited by concerns related to liability, cost, compliance, and missed opportunities for prevention counseling. The Society for Adolescent Medicine (SAM) recommends that providers who care for adolescents should do the following: use EPT as an option for STI care among chlamydiaor gonorrheainfected heterosexual males and females who are unlikely or unable to otherwise receive treatment; through SAM and AAP chapters, collaborate with policy makers to remove EPT legal barriers and facilitate reimbursement; and collaborate with health departments for implementation assistance.

Correlates of HIV Testing History among Urban Youth Recruited through Venue-Based Testing in 15 US Cities

Background: Adolescents and young adults comprise disproportionately high percentages of individuals living with human immunodeficiency virus (HIV) and those with undiagnosed HIV. Our objective was to determine factors associated with history of HIV testing and receipt of results among a sample of urban, high-risk, sexually active adolescents in 15 US cities. Methods: A total of 20 to 30 sexually active youths, aged 12 to 24 years, were recruited to participate in an anonymous survey and HIV antibody testing at 2 to 3 venues per city identified by young men who have sex with men, young women of color, or intravenous drug users. Results: Of the 1457 participants, 72% reported having been previously tested for HIV (89% of whom were aware of their test results). Our sample was diverse in terms of gender, race/ethnicity, and sexual orientation. Factors found to be predictive of testing typically reflect high risk for HIV, except for some high-risk partner characteristics, including having had a partner that made the youth have sex without a condom or had a partner with unknown HIV status. Factors associated with knowledge of serostatus are reported. HIV testing seems to be more associated with sexually transmitted infection testing services than with primary care. Conclusions: More strategies are needed that increase testing, including targeting partners of high-risk individuals, insuring receipt of test results, and increasing testing in primary care settings.

Brief Report: Preliminary Findings from a Pilot Health Care Transition Education Intervention for Adolescents and Young Adults with Special Health Care Needs

OBJECTIVE To assess acceptability and feasibility of a school-based health care transition education intervention designed to equip adolescents and young adults (A/YA) who have special health care needs with important health literacy, self-advocacy, and self-determination skills. METHODS A qualitative research approach was used to assess a 40-hr curriculum implemented with 137 A/YA in 13 high school special education classes. Three focus groups were conducted with 15 students and 7 educators. Participants were questioned about perceived relevance, readability, interest, ease of implementation and completeness of the curriculum. RESULTS All focus group participants said the curriculum was highly relevant and valuable. Teachers reported little difficulty with ease of implementation, though the reading level appeared high for some students. CONCLUSIONS This intervention model shows promise for empowering A/YA with special health care needs to become more independent in managing their health care, and warrants further development and evaluation. The curriculum is available at http://health.usf.edu/medicine/pediatrics/ad_med/resources.htm.

An Assessment of the Feasibility and Acceptability of a Friendship-Based Social Network Recruitment Strategy to Screen At-Risk African American and Hispanic/Latina Young Women for HIV Infection

OBJECTIVES To examine the feasibility and acceptability of a friendship-based network recruitment strategy for identifying undiagnosed human immunodeficiency virus (HIV) infection within young womens same-sex friendship networks and to determine factors that facilitated and hindered index recruiters (IRs) in recruiting female friendship network members (FNMs) as well as factors that facilitated and hindered FNMs in undergoing HIV screening. DESIGN A cross-sectional study design that incorporated dual incentives for IRs and their female FNMs. SETTING The IRs were recruited through 3 Adolescent Trials Network for HIV/AIDS Interventions sites within their Adolescent Medicine Trials Units. Data were collected from January 1, 2009, through June 30, 2010. PARTICIPANTS The IRs self-identifying as HIV positive, negative, or status unknown were enrolled to recruit FNMs to undergo HIV screening. MAIN OUTCOME MEASURES Self-reports of HIV risk and facilitators and barriers to network recruitment and HIV screening were assessed using an audio-computer-assisted self-interview. Participants were identified as HIV negative or positive on the basis of an OraQuick HIV test with confirmatory enzyme-linked immunosorbent assay and/or Western blot tests. RESULTS Nearly all (156 [98.1%]) eligible IRs agreed to participate and most (78.4%) recruited 1 or more FNMs. Of the 381 FNMs, most (342 [89.8%]) agreed to HIV screening. Although a high acceptance of HIV screening was achieved, the HIV prevalence was low (0.26%). CONCLUSION Our findings provide compelling evidence to suggest that use of a female friendship network approach is a feasible and acceptable means for engaging at-risk young women in HIV screening, as shown by their high rates of agreement to undergo HIV screening.

Human papillomavirus vaccine information, motivation, and behavioral skills among young adult US women

This study elicited the information needs, motivations, and behavioral skills related to human papillomavirus vaccine decision-making among young adult women. Interviews were conducted with college women, aged 18–26 years, and stratified by recently vaccinated (N = 25) and unvaccinated (N = 25). Comparative thematic analysis using the Information, Motivation, and Behavioral Skills Model was conducted. Healthcare providers were identified as the most trusted sources for information. While unvaccinated women did not have experience receiving the vaccine, they reported the same procedural knowledge for vaccination. These findings suggest that young adult women have the information and procedural knowledge for human papillomavirus vaccination, but motivations may influence their decision-making.

Preparing for Transition from Pediatric to Adult Care: Evaluation of a Physician Training Program

Clinical guidelines published by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians recommend systematic processes for transition from pediatric to adult health care as a standard of care for all adolescent and young adult patients (A/YA), with and without special health care needs. To address a knowledge gap in physician education, University of South Florida Health used a behavior change planning framework to develop and evaluate a transition training model for pediatrics and combined internal medicine and pediatrics residents that emphasizes the use of the electronic health records (EHR) as an experiential learning tool. Examination of program reach, effectiveness, adoption, and implementation indicates a positive intervention effect on selected dimensions of resident knowledge, confidence, and experience in health care transition as well as areas for program improvement. Continued

Health-care transition from adolescent to adult services for young people with HIV

HIV-related care and treatment engagement are crucial steps to improve individual and population-level health; yet, many young people (18-25 years old) with HIV are not maintained in, or disengage from, care. Health-care transition and the transfer to adult care are particularly vulnerable points in the care and treatment of young people with HIV. In this Review, we explore barriers and facilitators to health-care transition, evaluate existing health-care transition programmes, and identify best practices for the improvement of health-care transition outcomes and health. Although we examine health-care transition across a range of geographical regions, most examples are from the settings in which the most research has been done-the USA and western Europe.