Transition of adolescents living with HIV from pediatric to adult care, a retrospective 12-year Single Center Study from the Sahel Region in West-Africa

ABSTRACT

Transition is the next major hurdle in the field of HIV-infected youth, especially in sub-Saharan Africa. At St Camille Hospital in Ouagadougou, fully informed and compliant patients over 13-years-old were eligible for referral to the adult HIV/AIDS service, after completion of an individualized preparatory process. Transition consisted in at least two consecutive “joined-service” appointments in the respective facilities. We retrospectively compared immunological, clinical, and therapeutical data one year before transition, at transition and one year after transition. Between 2008 and 2019 73 patients (34 females, 39 males) were transitioned. All had been previously in pediatric care for at least 1 year and 66 were on HAART. Matched paired analysis of CD4 counts revealed a modest drop in CD4 cells over time (p < 0.05). Clinical data also showed strong fluctuation between WHO clinical stages over the three time points, with a clear trend towards increased severity especially post transfer. This large retrospective 12-year single-center experience from a Sahel country showed a 95.8% retention rate at one year. It demonstrates how a comprehensive plan, carefully implemented, can provide excellent retention, even in a low-resource setting. However, mild immunological decline was associated with a worrisome clinical deterioration, underlining the importance of assessing the latter after transition.

KEYWORDS:

• Adolescents
• HIV
• transition
• clinical stage
• Sahel region

Acknowledgements

The authors wish to thank Mireille Cissé (UNICEF), Agnès Thiombiano (RN), Alfred Sankara (psychologist), Claudine Farama (educational therapist) and Silvia Ferraris (art-therapist) for fruitful discussions, Alida Ilboudo (RN) for careful data collection and Francis Ouidiga for the retrieval of patients at risk to be lost to follow up.

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No potential conflict of interest was reported by the author(s).

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Funding

The author(s) reported there is no funding associated with the work featured in this article.