Faculty of Medicine, Chulalongkorn University
With the effective combination antiretroviral treatment for children living with HIV in the past decade, majority of HIV-infected children are survived and currently living in adolescent period. There is a need for transition care of perinatally HIV-infected children from pediatrics to adult care. Transition of care is a multifaceted, active process that attends to the medical, psychosocial, and academic or vocational needs of adolescents as they move from the child-focused to the adult-focused health-care system. Transition process involves the participation of the adolescent, family and both pediatric and adult health care teams. The transition is a planned and purposeful process, of which begins since a child was disclosed about his/her own HIV status. After HIV-infected child was disclosed about HIV status, health care providers and family members should empower him/her to get involve in HIV care, HIV monitoring, and long-term plans in order to gradual shift responsibility towards self-care.
The transition process involves several preparation steps include (1) assess the readiness of adolescent to assume responsibility for self-care (2) prepare adolescent to understand long-term antiretroviral treatment and learn his/her own medical conditions including CD4, HIV viral load (3) develop skills to navigate adult medical care services. There are several models of the transition e.g. transfer directly from pediatrics to adult clinics or set up an adolescent clinic to serve youth living with HIV both from perinataland behavioral-risk transmission.The on-going communication among health care providers to make a successful transition is crucial. The successful of transition can be assessed by several parameters e.g. retention in care, HIV treatment outcome, skills of seeking medical sevices , etc. Youth-friendly service should be an accessible and integrated health services with component of peer support without discrimination of sexuality and social status. During the session, the models of transition from HIV pediatric to adult care will be discussed. Tools developed by TREATAsia to support transition e.g. education flipchart, readiness assessment form, medical record transferal form will be shared. Adolescent period is bridging years from childhood to adult life. It is integral for children with chronic medical conditions including HIV infection to have a supportive medical services during this vulnerable milestone.
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