Supporting Youth from Pediatric- to Adult-Oriented HIV Care Across Two Metro Sites in the United States: Results from the iTransition Pilot Trial

Abstract

In the United States, youth are disproportionately affected by HIV and have poorer health outcomes than adults. Health care transition (HCT) from pediatric/adolescent- to adult-oriented HIV care is associated with disruptions to youths’ care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HIV-related HCT outcomes. Accordingly, our team designed and implemented the iTransition intervention to support youth and providers in navigating HIV-related HCT. We conducted a pilot trial of iTransition in two cities in the United States with four participant groups: (1) historical control group (n = 21), (2) youth intervention group (n = 33), (3) provider intervention group (n = 17), and (4) Transition Champions (i.e., staff members from each participating pediatric/adolescent and adult clinic designated to support iTransition implementation; n = 7). Analyses examined acceptability, feasibility, and preliminary efficacy. Youth, providers, and Transition Champions, who completed the assessments, generally assessed the feasibility and acceptability of the iTransition app and provider console favorably. Linkage to adult HIV care (defined as one adult HIV care appointment) was significantly higher in the youth intervention group, where 81.8% were linked compared with 47.6% in the historical control group (χ²= 6.96, p = 0.008). Rates of care linkage were not significantly different between app users and non-users (χ² = 1.09, p = 0.30). Notably, overall use of the app and the provider console was low. This study suggests that iTransition could serve as an important tool to support HCT for youth living with HIV in the United States; however, further work is needed to optimize implementation and improve uptake.