O2067: A Data Driven Process to the Development of National Policy Guidelines for Adolescent and Young Adults Living with HIV Transition of Care in Jamaica

Background: Children and adolescents living with HIV are surviving into adulthood in Jamaica. Successful transition of care from a pediatric to an adult-based facility is a critical factor in optimizing the health outcomes of adolescents and young adults living with HIV (AYALHIV). There is no formalized transition process for graduating AYALHIV into adult care in Jamaica. We aimed to i) characterize perception of facilitators and barriers by key stakeholders (AYALHIV, parents/guardians of AYALHIV, health care providers (HCPs), administrative staff of the Ministry of Health (MOHW), non-governmental and community-based organizations) and ii) assess AYALHIV level of transition readiness and self-management, exploring associations between psychological factors and AYALHIV transition readiness. These data would inform the development of evidence-based, culturally sensitive national policy transition guidelines for AYALHIV.

Methods: AYALHIV’s transition readiness was measured using the Successful Transition to Adulthood with Therapeutics = Rx (STARx) Questionnaire. Psychological factors were assessed utilizing the Center for Epidemiologic Studies Depression Scale (CESD-10), Generalized Anxiety Disorder Scale (GAD-7), and Rosenberg Self-esteem Scale. Focus group discussions (FGD) and semi-structured individual interviews were conducted with stakeholders. Thematic analysis was performed to identify main themes related to participants’ transition readiness.

Results: Eighty-two AYALHIV participated (male: n= 33, 40.2% ; female: n=49, 59.8%) with mean (SD) age 18.6 (SD3.4) years; 10-14y: n=10 (12.5%); 15-19y: n=33 (41.3%); 20-24y: n=37 (46.2%). Overall STARx scores were higher among female and older AYALHIV (p < 0.01). Twenty-nine (36.3%) AYALHIV were categorized as ‘at-risk’ for depression (CESD score >12) and 19 (23.8%) participants had moderate to severe anxious symptoms (GAD7 ≥10). No sex differences noted.
Focus group discussions (FGD) with AYALHIV prior to transfer identified the following themes - need for improved communication with AYALHIV regarding the pending transition, limited self-directed efforts to learn about HIV, fear of stigma and discrimination surrounding self-disclosure and high connectedness with pediatric providers contributing to a sense of loss. Post-transfer individual interviews (n=10) with AYALHIV, additionally identified initial displeasure, remorse and uncertainty when moving from the pediatric providers, however with time there was increased contentment. Parental FGDs and individual interviews highlighted difficulty separating from pediatric HCPs, maternal guilt, and perceived suboptimal emotional support from HCPs, family, and community. Administrative MOHW staff and HCPs (n= 10) corroborated similar themes identified by other stakeholders but additionally HCPs’ concern of not having a national protocol to guide the process of transition of care for AYALHIV.

Conclusion: AYALHIV in Jamaica and caregivers report being sub-optimally prepared for transition to adult care. These data will inform formulation of a fulsome transition policy guideline and targeted training and capacity building for all stakeholders, to enhance the likelihood of successful transition and optimized health outcomes for Jamaican AYALHIV.