Electronic Theses and Dissertations

Identifier

1203

Date

2014

Document Type

Dissertation (Access Restricted)

Degree Name

Doctor of Philosophy

Major

Social and Behavioral Sciences

Committee Chair

Satish Kedia

Committee Member

George Relyea

Committee Member

Vikki Nolan

Committee Member

Kenneth Ward

Abstract

Improving treatment for Human Immunodeficiency Virus (HIV) has resulted in greater survival of adolescents living with HIV. It is estimated that 40,000 adolescents are living with HIV in the U.S. Most of these adolescents obtain their medical care in a pediatric setting and will eventually transition their care to adult settings. Previous literature among non-HIV chronic illnesses have suggested poor transition of care can have a detrimental effect on clinical and health behavioral outcomes. Successful transition of care for HIV has been recognized as vital for improving individual as well as public health outcomes warranting further research. The purpose of this study was to examine post-transition outcomes from pediatric to adult health care among a sample of young individuals living with HIV in the mid-south region of the United States. Predictors of post-transition retention in care and HIV disease outcomes (viral load and CD4 cell count) were also examined. Medical records of patients transitioned from a pediatric HIV clinic to local adult providers in Memphis, TN, between January 01, 2008, and June 30, 2013 were retrospectively reviewed. Of the 166 patients initially eligible for the study, 117 were included in the retention outcome analyses and 84 were included in HIV disease biomarkers analyses. Approximately 70% of young people had attended an adult care clinic visit within 365 days post-transition of care. 57.4% had attended an adult clinic visit within 6-months after their final adolescent visit. Results indicated that subjects at post-transition had lower CD4 absolute count and percentage as well as higher viral loads. Completing the pediatric transition process and receiving an adult care referral as well as receiving transportation assistance and arrest history predicted post-transition retention. Pre-transition virologic failure and poverty status were significant predictors of CD4 count post-transition. This study was one of the first quantitative investigations of the outcomes of transition among young people living with HIV. By addressing the identified gap in the HIV transition literature, these results provide important information for determining outcomes and predictors of care transition. Findings support future research to prospectively examine transition outcomes to guide development of evidence-based interventions.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.

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