Adolescent and Young Adult Medicine
At the University of Maryland Children's Hospital, the Division of Adolescent and Young Adult Medicine is constantly involved in research that explores aspects of adolescent health, behavior, disease prevention, performance and attitudes towards health care, sexuality and HIV. The division participates in and designs studies that connect with young people and addresses their social and medical needs.
What kind of research is the Division of Adolescent Medicine conducting?
The Division of Adolescent and Young Adult Medicine is one of 15 sites in the Adolescent Medicine Trials Network (ATN) for HIV and AIDS Intervention. The primary mission is to conduct research both independently and in collaboration with the research network. In addition ATN includes community research partnerships to HIV prevention and vaccine studies. ATN initiatives have included clinical trials for HIV infected adolescents who have acquired infections sexually and perinatally. This initiative is now expanding to study responses to vaccines.
With hepatitis as a major public health problem, a new protocol looks at the response to hepatitis B vaccine in youth who are not HIV+ but are at risk of acquiring the infection. This is the first time we are considering an immune response to hepatitis B, which is more prevalent than HIV. Routinely the hepatitis B vaccine is given to children in three doses with the expectation that they will have a response, but through a previous study (the REACH) we found that there are a percentage of youth who were given the immunization and did not respond to it. Some teens still did not have a response, even after a fourth booster was administered.
Currently, pediatricians are mandated to give the immunization to youth, but the follow-up to make certain of a response is not mandated. The new protocol was created to find out what the response would be if we gave adolescents an adult dose of the vaccine. What we hypothesize is that the pediatric doses given were too small. Another arm to this study is combining the hepatitis B and hepatitis A vaccines and checking the response teens have to the combination.
Can you elaborate on some of the HIV trials you are part of?
One of our projects is called Project Impact for HIV+ youth. It is the first study in the country to examine adherence to medications and risk reduction in adolescents infected with HIV.
It consists of a curriculum that includes group sessions, individual sessions and home visits. In addition, we are including technology to help these teens build their skills in adhering to medication and to help them learn how to talk about their medical issues. These adolescents have been using Personal Digital Assistants (PDAs). The devices aid them just like they do adults to track appointments, keep notes, and stay organized. There is a special program on these PDAs designed to help with the use of medication. Not only are the youth reminded of appointments, but also there is a special note section where they can write any questions they wish to ask their providers. We hope to use this innovative way of skill building as a model for other health issues related to adolescent care. Examples include reproductive care, diabetes and asthma where there are major problems with adherence, such as taking daily medications for asthma, diabetes, etc. Because teens are so technologically savvy that they learn very fast, the acceptance rate is very good.
Another study is the Hormonal Ectopy Research (HER) study. It is a five-year research and service project funded by the National Institutes of Health, examining the biological factors that put girls at risk for acquiring a sexually transmitted infection (STI). A careful inspection of the ectopy area (where the tissue inside the uterus meets the tissue outside of the vagina) is done in girls between the ages of 12 and 18. The mucosal immunity of the vaginal area is being scrutinized in this study. Previous research findings show that the immune system in the vaginal and cervical areas is unique and differs from that of the blood. It is known that the ectopy is the most vulnerable area for acquiring an STI. This study's results could be the foundation of developing new products such as gels for preventing STIs.
Teens are seen every three months and receive screening and care for STIs. A photograph of the cervix is taken to determine if the size of the ectopy correlates with the acquisition of STIs. We are also looking at whether or not hormonal contraceptives impact the risk. This study also examines behavioral aspects that may put girls at higher risk, such as the use of alcohol and tobacco. In addition, counseling is offered for pregnancy prevention, safer sex and reduction of risk-behaviors.
The division also participates in research on counseling and testing for HIV, as well as consideration of innovative ways to determine new infections in HIV+ individuals by developing a detuned assay. Presently, efforts are being exerted in the division on an oral HIV test to differentiate the chronic from the recently infected. It is very cutting-edge.
We have a Prevention Team that educates teens about safer sex, STIs and other adolescent health issues at different venues in and around Baltimore. Our counseling and testing services (CTS) are also available and enable teens to be confidentially tested for HIV. The CTS team can test youth in the community during outreach events such as health fairs and presentations as well as test in the youth clinic on a walk in basis.
What makes the division unique?
Since the needs of teens differ greatly from children, the division is committed to fostering public and private partnerships to advocate for adolescents and their families. In a youth friendly environment, young people are treated with care and respect. We also respect the impact young people have on their own health care and keep several youth on our Community Advisory Boards.
Another unique feature of our division is the community research partnership called Connect to Protect,: (C2P). Currently, we are in Phase II of Connect to Protect: Baltimore. During Phase I, we looked at the community to see what kinds of HIV prevention services and programs are available for teens and compared this information with youth behavioral data in order to determine where youth are most in need and the resources available to protect them. Now in the Phase II, Connect to Protect: Baltimore will conduct a community assessment to find where youth are spending their time. The research team will work with community organizations to interview teens in the Baltimore City zip codes of 21217 and 21201.
We also educate communities and young people about the importance of vaccine development to protect the health of youth. Our aim is to see Baltimore benefit from vaccine development for diseases that drastically affect young people. Connect to Protect: Baltimore will be the foundation for future initiatives that will include addressing not only the need for youth to be vaccinated for diseases like hepatitis A and B, but HIV as well. It is important for the youth of the city and their caregivers to understand vaccines, and the Division of Adolescent and Young Adult Medicine at the University of Maryland hopes to address their questions and beliefs before and during any vaccine initiative.