Abstract
BACKGROUND: Most young adults with perinatal HIV (PHIV) transition from pediatric or adolescent to adult clinical care. Although guidelines to increase transition success have been recommended, we know little about uptake of these guidelines, particularly by adult care clinics. METHODS: We administered web-based surveys to adult care providers of young adults with PHIV in Massachusetts to evaluate transition preparation and post-transition evaluation practices. We compared transition practices and HIV care continuum outcomes by clinic setting. RESULTS: Twenty-four providers submitted information on 23 adult care clinics. Ten were hospital-based and 13 were community-based clinics. Community-based clinics were more likely than hospital-based clinics to conduct pre-transition (33% vs. 10%) and post-transition (67% vs. 30%) evaluation of patients' readiness to self-manage health care, and to share health outcome information with the pediatric/adolescent care team (50% vs. 20%). Community-based clinics were also more likely to have personnel dedicated to the transition process and to facilitate communication between the patient and pediatric/adolescent care team. Engagement in care was similar for young adults with PHIV seen at community-based and hospital-based clinics (88.2% vs. 85.5%; P = 1.00), but retention in care (76.5% vs. 50.5%; P = 0.05) and viral suppression (88.2% vs. 65.1%; P = 0.08) were higher in community-based than in hospital-based clinics. CONCLUSIONS: In Massachusetts, transition practices vary across adult clinics that care for young adults with PHIV. Recommended practices, and HIV care continuum outcomes, were more likely to be met at community-based clinics than hospital-based clinics. Community-based adult care may provide more comprehensive transition practices and serve as a model for hospital-based clinics.