1170-P: Barriers to Transition and Proposed Transition Methods from Pediatric to Adult Care—A Qualitative Study of Patients with Type 1 Diabetes in Gaborone, Botswana

Objective: The time of transition from pediatric to adult diabetes care is a high-risk period when many youth with Type 1 diabetes (T1D) have worsening glycemic control. The aim of this study was to conduct research to inform transition support for youth with T1D in low resource settings. Methods: In-depth interviews with patients between 16-25 years old diagnosed with T1D were conducted in Botswana. The interviews discussed diabetes care and support systems, perceived or experienced barriers and facilitators to transition, readiness, and four proposed transition support systems (orientation, peer support, text messaging, and designated clinic days). Interviews were coded independently by three investigators in NVivo and analyzed using the Consolidated Framework for Implementation Research. Results: Twenty-three patient interviews were conducted. The mean age of interviewed patients was 20.8 years (±2.88). Eight had transitioned to adult care. Among the 21 patients with a recent hemoglobin A1c, the mean was 10.4% (IQR 3.35). Patient reported inner setting factors impacting readiness included awareness and education surrounding transition, mental health resources, and relationships with providers. Outer setting themes impacting transition included acceptance and awareness of T1D in Botswana and cost of diabetes care. Of the four transition support strategies proposed, clinic orientation was universally supported. A designated clinic day was least supported due to a need for more flexibility. Conclusions: As the number of patients with T1D increases in Botswana, a systematic approach to support the transition from pediatric to adult care that is culturally relevant and addresses the needs of transitioning adolescents to optimize health is needed. Our study highlighted youth identified barriers and facilitators to successful transition and suggested the most acceptable low-cost support strategies.