Determinants of utilization of a no-cost HIV transition clinic: a cross-sectional study of young adults living with HIV/AIDS

Abstract

There is minimal research that has been conducted among young adults to understand the determinants of the utilization of human immunodeficiency virus (HIV) health services in this population. The purpose of this study was to explore the levels and determinants of HIV transition clinic (HTC) services utilization by young adults living with HIV/acquired immunodeficiency syndrome (YALHA). The study used a cross-sectional design and quantitative methods to collect data from a sample of 379 YALHA between the ages of 15–24 years who were registered clients of an HTC in Uganda. During data analysis, utilization was categorized into two levels: regular (kept all appointment visits) and irregular (missed one or more appointment visits) utilization. Univariable, bivariable, and multivariable logistic regression analyses were used to examine the determinants associated with HTC utilization. The HTC services that were most utilized by the YALHA were those based at the clinic and provided by professional health care providers and these were: clinical examination (96%); laboratory services (87.1%); and counseling (69.7%). The services that were least utilized were home visiting (5.8%) and peer support services (19.8%). Of the 379 YALHA, only 32.4% regularly utilized the HTC. Multivariable analysis showed that the main determinants of HTC utilization were CD4 count category of ≥251/μL (adjusted odds ratio [AOR] =0.58, 95% confidence interval [CI] =0.36–0.95); not being on antiretroviral therapy (AOR =0.27, 95% CI =0.15–0.47); and not receiving counseling services (AOR =0.47, 95% CI =0.27–0.83). Regular utilization of the HTC by YALHA was low and utilization seems to be influenced by HIV infection stage and HIV counseling services, but not sociodemographic factors or community factors.

Challenges and facilitators of transition from adolescent to adult HIV care among young adults living with HIV in Moshi, Tanzania

“…Initial transition preparation ranged from time of diagnosis to late teen years. The age for transition (25 years) proposed by participants in this study is older than the late teen or early twenties reported in most studies . Other studies proposed initiation of transition according to the youth’s level of maturity and self‐management capability .…”

Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent‐centred differentiated care model compared with standard of care: a nested case–control study at a tertiary referral hospital in Malawi

“…Médecins sans Frontières has also piloted a Youth Clubs program in Cape Town, including a structured interactive activity‐based session rooted in peer support that has been endorsed in the South African national adherence policy. Few interventions, however, have been described in the peer‐reviewed literature and evaluations have not looked at retention in care as an outcome . This is one of the first studies to date to look at the impact of an adolescent focused differentiated model of care on ART retention.…”

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

“…We did not find any national guidelines specifying an age for transition; however, in practice, we observed from available data that transition tends to occur across a wide age range (e.g. 13–22 years), with most occurring after 18 years [29], 20 years [35,39], or 22 years [40]. While chronological age is a standard criterion, it is also important to consider the age of maturity of the patient; in other disciplines, providers suggest that age of maturity may vary depending on social support, education, and learning capabilities [38].…”

“…June 2011 POC CD4 cell-count testing was introduced in youth clinic. Both had 3 ART preparation counselling session– Group B more receive CD4 cell count test result and their eligibility assessed (90% vs. 67%; relative risk [RR] = 2.4, 95%CI:1.8–3.4, p  < 0.0001)– No significant difference in the proportion starting and completing ART preparation counselling sessions 56% vs. 58% ( p  = 0.9).– 8 days reduction in the time from HIV testing to ART initiation in Group B, ( p  = 0.6).– The proportion of eligible patient who initiated ART was 44% and 50% ( p  = 0.6) in group A and group B, respectively, and a similar proportion were retained on therapy at three months after initiation (RR = 1.0, 95% CI:0.5–1.2, p  = 0.9)– No difference in the proportion of patients lost to follow-upNyabigambo,Adolescent health, Medicine and Therapeutics2014, AIDS care 2014 [40,46]Kampala,UgandaCross-sectional design and quantitative methods to collect data to study the levels (regular/irregular) and determinants (personal, health service delivery and community) of HIV transition clinic (HTC) services utilization by adolescents and young adults living with HIV379 adolescents and young adults 15–24 years, registered clients at an HTC between March and June 2012Infectious disease institute, with Wednesday monthly visits,and providing clinical examination, laboratory services, prevention mother-to-child transmission services, family planning services, treatment of sexually transmitted infections, ART psychosocial support, counselling, home visiting, peer support services, skills building programmes– 32% were regular utilizers of the HTC, mean age 22 years, 61% currently on ART.– 82% of regular utilizers were femalesNo relationship between reported wellbeing (measured with General Well-Being Schedule, 18-point scale) and attending all clinical visits (compared to missing at least one visit)– The most utilized services were: clinical examination (96%), laboratory (87%) and counselling (70%),– The less utilized: home visiting (6%,) peer support (20%).Individual correlates of HTC utilization– urban location: regular 56% vs. irregular 69%, p  = 0.016– age 15–19: regular 15% vs. irregular 9%, p  = 0.044– currently on ART: regular 82% vs. irregular 51%, p  = 0.000– last CD4 < 250: regular 37% vs. irregular 18%, p  = 0.000Community correlates:– not having a caregiver at home: regular 11% vs. irregular 22%, p  = 0.014Health services delivery correlates– no receiving counselling: regular 20% vs. irregular 36%, p  = 0.001Multivariable analysis: CD4 > 251 (adjusted Odds Ratio [AOR] = 0.58 95% CI = 0.36–0.95), not being on ART (AOR = 0.47, 95% CI = 0.15–0.47), not receiving counselling (AOR = 0.47, 95% CI = 0.27–0.83)McKenney, 2016 unpublished [39]Lilongwe, MalawiAssessment of a Transition Training programme, in Baylor College teen Clubs800 adolescents, 18–24 years, 106 graduate participants, from 2013 to 20156-week Transition Training programme to transfer to adolescents economic, psychosocial, and self-care skills needs to make a successful transition into adulthoodMean age: 20 years23% have disclosed their HIV status to friends/partners; 25% were enrolled in secondary school, and 3% in university; 10% found employment, 8% were involved as ambassadors for...…”

“…However, regular utilization of these services by adolescents and youth living with HIV was found to be low, reaching only 32% in 2012. In an analysis of factors associated with utilization, it seemed to be HIV infection stage and availability of HIV counselling services were associated with greater attendance while socio-demographic or community factors were not [40,46]. Further studies of this model are needed to measure post-transition outcomes among adolescents and youth accessing HTC care.…”