abstract: 'Background Ageing into adulthood is challenging at baseline, and doing

  so with a chronic disease can add increased stress and vulnerability.

  Worldwide, a substantial care gap exists as children transition from

  care in a paediatric to adult setting. There is no current consensus on

  safe and equitable healthcare transition (HCT) for patients with chronic

  disease in resource-denied settings. Much of the existing literature is

  specific to HIV care. The objective of this narrative review was to

  summarise current literature related to adolescent HCT not associated

  with HIV, in low-income and middle-income countries (LMICs) and other

  resource-denied settings, in order to inform equitable health policy

  strategies. Methods A literature search was performed using defined

  search terms in PubMed and Cumulative Index to Nursing and Allied Health

  Literature databases to identify all peer-reviewed studies published

  until January 2020, pertaining to paediatric to adult HCT for

  adolescents and young adults with chronic disease in resource-denied

  settings. Following deduplication, 1111 studies were screened and

  reviewed by two independent reviewers, of which 10 studies met the

  inclusion criteria. Resulting studies were included in thematic analysis

  and narrative synthesis. Results Twelve subthemes emerged, leading to

  recommendations which support equitable and age-appropriate adolescent

  care. Recommendations include (1) improvement of community health

  education and resilience tools for puberty, reproductive health and

  mental health comorbidities; (2) strengthening of health systems to

  create individualised adolescent-responsive policy; (3) incorporation of

  social and financial resources in the healthcare setting; and (4)

  formalisation of institution-wide procedures to address

  community-identified barriers to successful transition. Conclusion

  Limitations of existing evidence relate to the paucity of formal policy

  for paediatric to adult transition in LMICs for patients with

  childhood-onset conditions, in the absence of a diagnosis of HIV. With a

  rise in successful treatments for paediatric-onset chronic disease,

  adolescent health and transition programmes are needed to guide

  effective health policy and risk reduction for adolescents in

  resource-denied settings.'
affiliation: 'Ratner, L (Corresponding Author), Harvard Med Sch, Div Resp Med, Boston
  Childrens Hosp, Boston, MA 02115 USA.

  Ratner, L (Corresponding Author), Brigham \& Womens Hosp, Div Gen Internal Med,
  Boston, MA 02115 USA.

  Narla, Nirmala Priya; Russ, Christiana M., Harvard Med Sch, Div Med Crit Care, Boston
  Childrens Hosp, Boston, MA USA.

  Narla, Nirmala Priya, Univ Texas Hlth Sci Ctr Houston, Dept Pediat, Houston, TX
  USA.

  Ratner, Leah, Harvard Med Sch, Div Resp Med, Boston Childrens Hosp, Boston, MA 02115
  USA.

  Ratner, Leah, Brigham \& Womens Hosp, Div Gen Internal Med, Boston, MA 02115 USA.

  Bastos, Fernanda Viera, Hosp Clin Univ Sao Paolo, Med Sch, Sao Paulo, Brazil.

  Owusu, Sheila Agyeiwaa; Osei-Bonsu, Angela, Komfo Anokye Teaching Hosp, Directorate
  Child Hlth, Kumasi, Ghana.'
article-number: e001059
author: Narla, Nirmala Priya and Ratner, Leah and Bastos, Fernanda Viera and Owusu,
  Sheila Agyeiwaa and Osei-Bonsu, Angela and Russ, Christiana M.
author-email: Leah.Ratner@childrens.harvard.edu
author_list:
- family: Narla
  given: Nirmala Priya
- family: Ratner
  given: Leah
- family: Bastos
  given: Fernanda Viera
- family: Owusu
  given: Sheila Agyeiwaa
- family: Osei-Bonsu
  given: Angela
- family: Russ
  given: Christiana M.
da: '2023-09-28'
doi: 10.1136/bmjpo-2021-001059
eissn: 2399-9772
files: []
journal: BMJ PAEDIATRICS OPEN
keywords: adolescent health; social work; health services research
keywords-plus: ADOLESCENTS; YOUTH; DISABILITIES; VALIDATION; READINESS; SERVICES;
  NEEDS
language: English
number: '1'
number-of-cited-references: '29'
orcid-numbers: 'Owusu, Sheila Agyeiwaa/0000-0002-5172-2842

  Narla, Nirmala/0000-0002-6152-9245

  Vieira Bastos, Fernanda/0009-0007-2037-8720

  Osei-Bonsu, Angela/0000-0002-0468-1160

  Ratner, Leah/0000-0001-6326-3543'
papis_id: ed9ea126fea3cebae20c133f563da584
ref: Narla2021paediatricadult
researcherid-numbers: 'Owusu, Sheila Agyeiwaa/AAE-8025-2022

  owusu, Sheila Agyeiwaa/ITT-2132-2023

  '
tags:
- review
times-cited: '11'
title: 'Paediatric to adult healthcare transition in resource-limited settings: a
  narrative review'
type: article
unique-id: WOS:000642174300001
usage-count-last-180-days: '0'
usage-count-since-2013: '4'
volume: '5'
web-of-science-categories: Pediatrics
year: '2021'