New survey tool can predict whether adolescents are ready to move to adult HIV care
The HARTS trial suggests age should not be used to judge readiness to move, as things such as being able to understand treatment and ask questions are more important
Researchers in South Africa have developed a new survey tool that can predict whether adolescents with HIV are ready to move into adult care.
The HIV Adolescent Readiness for Transition Scale (HARTS) is a 15-question survey that assesses whether adolescents are ready to move to adult HIV care or need more support before moving.
Researchers developed HARTS because of the high numbers of adolescents that leave adult HIV care after moving from a children's clinic. Currently, no guidelines exist to help healthcare providers decide whether an adolescent is ready to move or not.
Researchers developed HARTS over three years, between 2016 and 2019. They based it on similar surveys for adolescents with other chronic conditions.
They developed the survey in stages. Each stage involved feedback from healthcare providers and young people in South Africa who were about to move into adult HIV care.
The final version of HARTS was tested on 199 adolescents (ages 12-15, median age 13) from the township of Umlazi, Durban.
After taking the survey, the group moved to adult HIV care and researchers followed them for 12 months. At 12 months, 57% were virally suppressed.
The research found four factors influenced whether an adolescent was likely to be virally suppressed after 12 months in adult HIV care. The first is whether the individual knows they have HIV and feels able to tell others (HIV disclosure). The second is whether they feel comfortable getting services at a clinic without an adult (health navigation). The third is whether they understand their treatment and care (health literacy). The fourth is whether they take responsibility for their treatment and are able to raise issues with healthcare providers (self-advocacy).
Adolescents with low levels of self-advocacy, HIV disclosure and health navigation were more likely to experience viral failure in adult care than other adolescents.
The research did not find that someone's age was a factor in whether they would go on to have effective treatment at an adult clinic. This is despite many children's HIV clinics using an adolescent’s age to decide whether they are ready to move to adult care.
Adolescents scoring 45 points or more on HARTS were likely to be able to move to adult care without any extra support and be virally suppressed at 12 months. HARTS was 90% accurate in predicting this.
Those scoring less than 45 points were likely to need more time or support before moving.
Adolescents who are not ready to move may benefit from targeted support, based on scores of the individual HARTS categories.