scholarly journals AN ASSESSMENT OF CHALLENGES INFLUENCING ACCESS TO COMPREHENSIVE HIV CARE AMONG ADOLESCENTS AND YOUTH AGED 15-24 YEARS AT NAKURU COUNTY REFERRAL HOSPITAL IN KENYA

2020 ◽  
Vol 5 (2) ◽  
pp. 13-47
Author(s):  
Chirchir Matthew Kimeli ◽  
Eddah Cheruiyot ◽  
James Waweru ◽  
Richard Sumukwo ◽  
Nanyorri Nalama ◽  
...  
Keyword(s):  
Cognitive Theory ◽  
Psychosocial Support ◽  
Peer Pressure ◽  
Hospital Management ◽  
Referral Hospital ◽  
Poor Adherence ◽  
Hiv Care ◽  
Youth Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

Purpose: Adolescents and youth living with HIV/AIDs experience numerous challenges and support needs, some of which occur in school and affect their quality of life. Several reasons have been advanced to explain this trend includes; stigma, peer pressure and discrimination. However, little focus has been made on socio-cultural, socioeconomic and clinical challenges facing Adolescents and Youth Living with HIV/AIDS (AYLHIV). The objective of this study was to assess the challenges influencing access to comprehensive HIV care among adolescents and youth aged 15-24 years at Nakuru county referral hospital in Kenya.Methodology: Adopting social cognitive theory, a descriptive survey research design was used. Purposive and proportionate random sampling techniques were used to obtain a sample size of 47 AYLHIV. Questionnaires and focused group discussions were used to collect data from AYLHIV; while Interview schedules were to collect data from counsellors in November 2019. Data were analyzed by the use of descriptive statistics in January 2020.Findings: The study concludes that the main socio-cultural challenges faced by AYLWA at County Referral Hospitals are stigma and frequent change of caregivers resulting in poor adherence to ARV medications. Moreover, no major socio-economic challenges were affecting AYLWA at the health facilities. Further, the main clinical challenges facing AYLWA were poor adherence and low viral suppression.Unique Contribution to Theory, Practice and Policy: The study recommends the need to offer and strengthen psychosocial support to AYLWA to enable them to cope with their status and educate the caregivers on the importance of the AYLWA having a consistent caregiver for continuity. The hospital management should avail more trained adherence counsellors for this role. Moreover, the hospital management needs to strengthen the Youth Friendly HIV services to improve responsiveness to the youth needs. This will enhance peer support.

scholarly journals An Intervention for the Transition From Pediatric or Adolescent to Adult-Oriented HIV Care: Protocol for the Development and Pilot Implementation of iTransition

10.2196/24565 ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. e24565
Author(s):  
Amanda E Tanner ◽  
Nadia Dowshen ◽  
Morgan M Philbin ◽  
Kelly L Rulison ◽  
Andres Camacho-Gonzalez ◽  
...  
Keyword(s):  
Data Collection ◽  
Social Cognitive ◽  
Cognitive Theory ◽  
Phase 1 ◽  
Hiv Care ◽  
Phase 2 ◽  
Pilot Implementation ◽  
Youth Living With Hiv ◽  
Living With Hiv ◽  
Implementation Trial

Background In the United States, adolescents and young adults are disproportionately affected by HIV and have poorer HIV-related health outcomes than adults. Health care transition (HCT) from pediatric or adolescent to adult-oriented HIV care is associated with disruptions to youths’ care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HCT outcomes for youth living with HIV. Objective There are 2 phases of this project. Phase 1 involves the iterative development and usability testing of a Social Cognitive Theory–based mobile health (mHealth) HIV HCT intervention (iTransition). In phase 2, we will conduct a pilot implementation trial to assess iTransition’s feasibility and acceptability and to establish preliminary efficacy among youth and provider participants. Methods The iterative phase 1 development process will involve in-person and virtual meetings and a design team comprising youth living with HIV and health care providers. The design team will both inform the content and provide feedback on the look, feel, and process of the iTransition intervention. In phase 2, we will recruit 100 transition-eligible youth across two clinical sites in Atlanta, Georgia, and Philadelphia, Pennsylvania, to participate in the historical control group (n=50; data collection only) or the intervention group (n=50) in a pilot implementation trial. We will also recruit 28 provider participants across the pediatric or adolescent and adult clinics at the two sites. Data collection will include electronic medical chart abstraction for clinical outcomes as well as surveys and interviews related to demographic and behavioral characteristics; Social Cognitive Theory constructs; and intervention feasibility, acceptability, and use. Analyses will compare historical control and intervention groups in terms of HCT outcomes, including adult care linkage (primary), care retention, and viral suppression (secondary). Interview data will be analyzed using content analysis to understand the experience with use and acceptability. Results Phase 1 (development) of iTransition research activities began in November 2019 and is ongoing. The data collection for the phase 2 pilot implementation trial is expected to be completed in January 2023. Final results are anticipated in summer 2023. Conclusions The development and pilot implementation trial of the iTransition intervention will fill an important gap in understanding the role of mHealth interventions to support HCT outcomes for youth living with HIV. International Registered Report Identifier (IRRID) DERR1-10.2196/24565

Adolescent Trials Network for HIV-AIDS Scale It Up Program: Protocol for a Rational and Overview (Preprint)

2018 ◽  
Author(s):  
Sylvie Naar ◽  
Jeffrey T Parsons ◽  
Bonita F Stanton
Keyword(s):  
Implementation Science ◽  
Large Body ◽  
Hiv Infections ◽  
Self Management ◽  
Management Interventions ◽  
Hiv Research ◽  
The Individual ◽  
Youth Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

BACKGROUND The past 30 years have witnessed such significant progress in the prevention and treatment of HIV/AIDS that an AIDS-free generation and the end to the global AIDS epidemic are ambitious, but achievable, national and global goals. Despite growing optimism, globally, youth living with HIV are markedly less likely to receive antiretroviral therapy than adults (23% vs 38%). Furthermore, marked health disparities exist regarding HIV infection risk, with young men of color who have sex with men disproportionately affected. A large body of research has identified highly impactful facilitators of and barriers to behavior change. Several efficacious interventions have been created that decrease the rate of new HIV infections among youth and reduce morbidity among youth living with HIV. However, full benefits that should be possible based on the tools and interventions currently available are yet to be realized in youth, in large part, because efficacious interventions have not been implemented in real-world settings. Scale It Up (SIU) primarily aims to assemble research teams that will ultimately bring to practice evidence-based interventions that positively impact the youth HIV prevention and care cascades, and in turn, advance the fields of implementation science and self-management science. OBJECTIVE This paper aims to describe the structure of the U19-SIU and the effectiveness-implementation hybrid trials, as well as other center-wide protocols and initiatives, implemented within SIU. METHODS SIU will achieve its aims through 4 individual primary protocols, 2 center-wide protocols, and 3 cross-project initiatives. RESULTS SIU was funded by National Institute for Child Health and Human Development (U19HD089875) and began in October 2016. As of November 2018, 6 SIU protocols have launched at least the first phase of work (ATN 144 SMART: Sequential Multiple Assignment Randomized Trial; ATN 145 YMHP: Young Men’s Health Project; ATN 146 TMI: Tailored Motivational Interviewing Intervention; ATN 153 EPIS: Exploration, Preparation, Implementation, Sustainment model; ATN 154 CM: Cascade Monitoring; ATN 156 We Test: Couples' Communication and HIV Testing). Further details can be found in the individual protocol papers. CONCLUSIONS To date, the youth HIV research portfolio has not adequately advanced the important care area of self-management. SIU protocols and initiatives address this broad issue by focusing on evaluating the effectiveness and implementation of self-management interventions. SIU is highly innovative for 5 primary reasons: (1) our research framework expands the application of “self-management”; (2) the 4 primary protocols utilize innovative hybrid designs; (3) our Analytic Core will conduct cost-effectiveness analyses of each intervention; (4) across all 4 primary protocols, our Implementation Science Core will apply implementation scales designed to assess inner and outer context factors; and (5) we shall advance understanding of the dynamics between provider and patient through analysis of recorded interactions. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11204

scholarly journals Care and support for youth living with HIV/AIDS in secondary schools: perspectives of school stakeholders in western Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmanuel Kimera ◽  
Sofie Vindevogel ◽  
Didier Reynaert ◽  
Anne-Mie Engelen ◽  
Kintu Mugenyi Justice ◽  
...  
Keyword(s):  
Secondary Schools ◽  
Qualitative Inquiry ◽  
Resource Limited ◽  
Care And Support ◽  
Gradual Process ◽  
Youth Living With Hiv ◽  
Living With Hiv ◽  
Western Uganda ◽  
Hiv Aids ◽  
School Stakeholders

Abstract Background Although schools have been identified as significant settings in the response to the HIV/AIDS pandemic, limited research is available on how they can accommodate Youth Living with HIV/AIDS (YLWHA), especially in resource limited countries. In this study, we explored strategies by school stakeholders (school staff, parents/caretakers, and students) in western Uganda to care for and support YLWHA in their schools. Methods The article utilizes data collected between May and October, 2019 from a qualitative inquiry based on focus group discussions and interviews with 88 school stakeholders purposively selected from 3 secondary schools in western Uganda. Textual data was analyzed thematically involving both inductive and deductive coding. Results We identified 7 overarching interrelated themes in which participants reported strategies to care for and support YLWHA: counselling and guidance; social support networks and linkages; knowledge and skills; anti-stigma and anti-discrimination measures; disclosure of HIV status; treatment and management of HIV/AIDS; and affirmative actions for YLWHA. Stakeholders’ strategies often differed regarding what was considered appropriate, the approach and who to take lead in supporting YLWHA. Conclusions Despite the limited care and support strategies specific for YLWHA currently available in schools, our study points to optimism and high potential given stakeholders’ identified avenues for improvement. We posit that promoting HIV/AIDS-care and support in schools is a gradual process requiring each school to develop a strong knowledge base about HIV/AIDS and support needs of YLWHA, develop a coherent and school-wide approach, and collaborate extensively with external stakeholders who are significant in supporting YLWHA.

scholarly journals Improving Adherence to Anti-retroviral Therapy among Persons Living with HIV/AIDS in Enugu State, South East Nigeria

2019 ◽  
pp. 1-9
Author(s):  
C. P. Igweagu ◽  
O. H. Chime ◽  
C. N. Onwasigwe
Keyword(s):  
Health Education ◽  
Poor Adherence ◽  
Public Health Issue ◽  
People Living With Hiv ◽  
Study Group ◽  
Control Groups ◽  
Persons Living With Hiv ◽  
Enugu State ◽  
Living With Hiv ◽  
Hiv Aids

HIV/AIDS continues to be a major global public health issue, having claimed more than 32 million lives so far. There were approximately 37.9 million people living with HIV/AIDS (PLHIV) at the end of 2018. Anti-retroviral therapy (ART) has significantly reduced morbidity and mortality and improved quality of life among people with HIV infection. Aims: The study was conducted to improve the knowledge and adherence to anti-retroviral therapy among PLHIV in Enugu state, southeast Nigeria. Study Design: Interventional study. Place and Duration of Study: Anti-retroviral Therapy clinics within Enugu metropolis in Enugu state Nigeria between June to December 2018. Methodology: A health education intervention was carried out among 312 PLHIV receiving ART in Enugu metropolis to improve their perception and adherence to antiretroviral therapy. A structured questionnaire was used to collect data from 312 PLHIV (156 each in the study and control groups), who were selected by multistage sampling. Subsequently, health education was conducted among the study group. Three months after this intervention its effects were assessed through a survey using the same structured questionnaires employed in the baseline survey.  Results: The most frequently occurring reason given by the respondents for poor adherence to ART was forgetfulness (65.4% for study and 69.9% for control groups). Knowledge of the factors and consequences of poor adherence to treatment was significantly higher among the study group than the controls post-interventions p<0.001. Adherence to ART improved from 42.3% pre-intervention to 81.4% post-intervention. Conclusion: Intensive health education effectively improved adherence to ART among persons living with HIV/AIDS and this should be carried out regularly.

Motivational Interviewing and the Adolescent/Young Adult HIV Care Continuum

2019 ◽  
pp. 37-46
Author(s):  
Sylvie Naar ◽  
Maurice Bulls
Keyword(s):  
Young Adult ◽  
Motivational Interviewing ◽  
Behavioral Therapy ◽  
Hiv Care ◽  
Behavior Changes ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Future Direction ◽  
Youth Living With Hiv ◽  
Living With Hiv

This chapter explores the HIV care continuum specifically with youth living with HIV (YLH). The authors review relevant HIV statistics, including the trends in YLH. The authors then examine the fit of motivational interviewing (MI) with adolescent development, arguing that it is an excellent strategy to include in promoting self-management of HIV. Multiple examples are also provided for programs and interventions using MI with youth. This chapter provides specific details on how MI can be leveraged in working with YLH, although many of these insights can generalize to adult populations. In the final section, the authors examine the future direction of MI in the care of YLH. They argue that once MI has helped to motivate YLH toward change, the substitution for or addition of cognitive-behavioral therapy (CBT) may be warranted. In this way, the more action-oriented strategies of CBT strengthen the behavior changes that MI has helped to put in motion.

scholarly journals 1309. Effects of a Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Service in Persons Living with HIV/AIDS

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S471-S472
Author(s):  
Marisa B Brizzi ◽  
Rodrigo M Burgos ◽  
Thomas D Chiampas ◽  
Sarah M Michienzi ◽  
Renata Smith ◽  
...  
Keyword(s):  
Care Service ◽  
Transitions Of Care ◽  
Hiv Care ◽  
Outpatient Clinics ◽  
Readmission Rates ◽  
Implementation Phase ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Background Historical data demonstrate that PLWHA experience higher rates of medication-related errors when admitted to the inpatient setting. Prior to initiation of this program, rapid-start initiation of antiretroviral therapy (ART) was not implemented prior to discharge. The purpose of this study was to evaluate the impact of a pharmacist-driven antiretroviral stewardship and transitions of care service in persons living with HIV/AIDS (PLWHA). Methods This was a retrospective pre- and post-analysis of PLWHA hospitalized at University of Illinois Hospital (UIH). Patients included were adults following at UIH outpatient clinics for HIV care admitted to UIH for acute care. Data were collected between April 19, 2017 and October 19, 2017 for the pre-implementation phase, and between July 1, 2018 and December 31, 2018 for the post-implementation phase. The post-implementation phase included an HIV-trained clinical pharmacist (Figure 1). Primary and secondary endpoints included follow-up rates at UIH outpatient HIV clinics, 30-day readmission rates, and access to medications at hospital discharge. Statistical analysis included descriptive statistics and Fisher’s Exact test. Results A total of 119 patients were included in the analysis, 66 in the pre-implementation phase and 53 in the post-implementation phase. Patients included were mostly black males with median age of 48. In the pre-implementation phase 50 out of 65 (77%) patients attended follow-up visits for HIV care at UIH outpatient clinics, vs. 42 out of 47 (89%) patients in the post-implementation phase (P = 0.1329). Thirty-day readmission occurred in 17 of 62 (27%) patients in the pre-implementation phase vs. 5 of 52 (10%) of patients in the post-implementation phase (P = 0.0183). During the post-implementation phase, the HIV pharmacist secured access of ART and opportunistic infection medications prior to discharge for 22 patients (42%), 2 of which were new diagnoses. Conclusion A pharmacist-led antiretroviral stewardship and TOC program led to a decrease in 30-day readmission rates in PLWHA. Although not significant, the HIV-pharmacist led to higher rates of clinic follow-up. Finally, the HIV-pharmacist helped secure access to ART and initiate rapid-start therapy in newly diagnosed patients prior to leaving the hospital. Disclosures All authors: No reported disclosures.

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