June 25, 2013
The American Academy of Pediatrics (AAP) has issued a policy statement on how to transition HIV-infected adolescents to adult healthcare. AAP recommends clinics follow four steps to guide HIV-positive teens to successfully maintain healthcare: create a formal, written transition care plan; begin communications about HIV status and transition when the patient is approximately age 12; make the transition when the patient is between 18-25 years; and document and evaluate the transition when it is completed.
The authors, Russell B. Van Dyke, M.D., F.A.A.P., and Rana Chakraborty, M.D., of AAP's Committee on Pediatric AIDS, contend that pediatricians and adolescent and family medicine providers have the very important function of arranging a smooth and effective transition at this difficult time of life for both the HIV-infected youth and their families. They advise that the written care plan should include supporting documents to assist the new team, including goals and a timeline. Also an important part of the plan is a system similar to a registry to track the youths' progress through the transition process, to reduce the possibility of a loss of care due to moving away from the family home.
The plan must include education for all parties involved and empower the HIV-infected youths to assume responsibility for their own healthcare. The authors emphasized the importance of encouraging the adolescent patients' independence through personally owning and managing their healthcare. They also advised the pediatrician or family providers to be aware of and address behavioral, emotional, and mental health problems.
The plan recommends direct contact between providers and sending a letter of transition, portable medical summary, and electronic health records before the transfer. Also, the pediatrician or family physician should introduce the adolescent patient to the provider personally. A member of the referring physician's healthcare team should show support by contacting the patient periodically and, if necessary, the youth should seek out a peer support group to help deal with anxiety from the transition. The plan advised the referring physician to exit once adult care was established.
The full report, "Transitioning HIV-Infected Youth Into Adult Health Care," was published online in the journal Pediatrics (2013; doi: 10.1542/peds.2013-1073).