1. What does transfer mean in SSA
What does transfer mean in SSA? Patterns of transfer in Southern African perinatally HIV-infected adolescents
Mary-Ann Davies, Shobna Sawry, Sam Phiri, Helena Rabie, Brian Eley, Geoff Fatti, Karl Technau, Frank Tanser, Robin Wood, Janet Giddy, Carolyn Bolton-Moore, Cleophas Chimbetete, Rohan Hazra, Olivia Keiser and Kathryn Stinson for the IeDEA Southern Africa Collaboration
19 July, Durban

2. The wave of perinatally HIV-infected adolescents (PHA)

3. Growing population of PHA
On ART
Eligible, not on Rx
Not eligible
Johnson et al. PIDJ 2012

4. Changing age-structure of PHA in IeDEA-SA Age at last FU in those starting ART at <10 years
2008 N=15,144; 14%>10 years old
2014
N=28,520; 22%>10 years old

5. Outcomes of PHA by 13 years of age competing risks estimation
Transfer out
18.2% ( )
LTFU
9.3% ( )
Death
1.2% ( )

6. Is transfer the same as transition?
Specialist pediatric
→ adult care
Completely integrated care
Irrespective of model – transition is STILL happening
Children stop coming with caregivers
HCW talk to them about different things eg SRH needs
Stop measuring height
Use different form
Illustrated by the cartoon – where it’s heading in HIV care – autonomy
Transition ≈ Transfer
?Transfer

7. Objective
To describe transfer patterns in PHA during first 3 years of adolescence – ages years.

8. Methods
Routinely collected data from 12 IeDEA-SA cohorts in 4 countries
Inclusion criteria
ART initiation at <9.5 years
Remaining in care beyond 10 years of age
Outcome = Transfer out (TFO)
Characteristics of patients transferring
K-M probability of transfer by cohort
Predictors of transfer out
Malawi
Zambia
Zimbabwe
South Africa

9. Results: Characteristics at ART start for those remaining in care (RIC) or TFO n=3657 (excludes children died and LTFU within 6 months)

10. Results: Characteristics at transfer (TFO) or last visit (remaining in care)

11. Probability of transfer for different cohorts 25.6% (24.0 to 27.4)
14.0% ( ) (pre-2009); 34.4% (31.8 – 37.1)(≥2009)
Primary care cohorts
Probability of transfer
6.5 ( )
5.1 ( )
10.1 ( )
14.8 ( )
17.3 ( )
Hospital cohorts
36.3 ( )
7.6 ( )
45.3 ( )
45.0 ( )
54.3 ( )
Months from 10 years of age

12. Characteristics associated with transfer

13. Limitations Documented transfers – not “silent transfers”
Outcomes in patients who transfer out?

14. Outcomes after transfer using linkage
Patients transferring out of a hospital site.
Western Cape Province of South Africa – unique identifiers since 2007 – link to laboratory data.
“Successful transfer” – having a laboratory test at the transfer site after transfer.
75% had a lab test result after transfer
Lab testing only about 90% complete >80% of children successfully transferred
Arowosegbe et al. P_66
HIV Pediatrics Workshop 2016

15. Conclusions
About 1 in 4 patients transfer during early adolescence at a relatively constant rate, but wide variation between cohorts.
“Healthier” patients were more likely to be transferred.
on ART for longer, ↑CD4 values, ↓HIV-RNA
Understanding patterns of transfer and outcomes after transfer is critical to evaluating adolescent and adolescent transition outcomes.

16. With many thanks to…
Patients, caregivers, staff and site investigators from all IeDEA-SA sites
IeDEA Data Centres
NIAID, NICHD, NCI, NIDA, NIMH