Date of Award

January 2016

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Elijah Paintsil

Abstract

Successful public access to antiretroviral therapy in resource-limited settings (RLS) has resulted in survival of HIV perinatally infected children into adulthood. There are few studies on transition of care in RLS, where 90% of HIV-infected children reside. We aimed to characterize the current landscape of the transfer process of HIV-infected adolescents in one such RLS, Jamaica. We conducted in-depth interviews of 18 HIV-infected adolescents in pediatric care and 21 health care providers. We analyzed the data using the grounded theory approach. Five themes emerged: 1. Pediatric clinics were like families who provided care-taking and developmental support in addition to HIV care. 2. Participants felt the quality of care adolescents received in the pediatric clinic was better than it would be in the adult setting. 3. Given the social significance of pediatrics clinics in participants’ lives, alongside the concerns regarding adult care, there was rootedness in the pediatric clinic. 4. In the face of the national policy of transfer to adult care at 13, some physicians sought to bridge the gap between childhood and adulthood by providing adolescent-centered services. 5. Narratives speak to the transfer as a critical juncture in adolescents’ care and a transition as holistic process. We conclude that a formal process of transition is necessary.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 08/23/2017.

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