Health provider training is associated with improved engagement in HIV care among adolescents and young adults in Kenya

Abstract

Objectives: Adolescents and young adults (AYA) have poorer retention, viral suppression, and survival than other age groups. We evaluated correlates of initial AYA engagement in HIV care at facilities participating in a randomized trial in Kenya. Design: Retrospective cohort studyMethods: Electronic medical records from AYA ages 10-24 attending 24 HIV care facilities in Kenya were abstracted. Facility surveys assessed provider trainings and services. HIV provider surveys assessed AYA training and work experience. Engagement in care was defined as return for first follow-up visit within 3 months among newly enrolled or recently re-engaged (returning after >3 months out of care) AYA. Multi-level regression estimated risk ratios (RRs) and 95% Confidence Intervals (CIs), accounting for clustering by facility. Final models adjusted for AYA individual age and median AYA age and number enrolled per facility.

Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia

“…changed the way they see and interact with all of their AYA patients [54]. Such changes may have influenced HIV outcomes among comparison arm participants as they were attended to by the same HCP as the intervention participants [55]. Purposive sampling of study sites and consecutive sampling of study participants may also introduce selection bias and limit generalizability of the study findings.…”

Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

“…64,68 Approaches such as HIV-self testing have already demonstrated high acceptability among youth sub-Saharan African settings 69 and could be a pathway to virtual LTC and online care coordination-both of which were identified as service delivery preferences among young MSM in Ghana. 15 Facility-based adolescent care capacity-building and stigmareduction trainings were associated greater likelihood of HIV care engagement among Kenyan youth living with HIV (RR ¼ 1.56, 95% CI: 1.13-2.16) 70 and may offer insights for reducing stigma and increasing capacity to work with adolescent MSM in Ghanaian healthcare facilities.…”

Training Exposure and Self-Rated Competence among HIV Care Providers Working with Adolescents in Kenya

“…Health care worker respondents were mostly female (71.8%), a median of 33 years old (IQR: [29][30][31][32][33][34][35][36][37][38][39], and nearly all reported postsecondary education (95.8%). The HCWs reported a median of 4 years (IQR: 2-8) of experience providing HIV care for all-age populations and slightly fewer years in providing care specifically to ALWH (median ¼ 3 years, IQR:1-6).…”

“…Prior analyses in Kenyan HIV care programs demonstrated an association between the proportion of HCWs within a facility who have been trained in adolescent-friendly care and increased retention among ALWH in care. 39 This is supported by research showing that the degree to which an HCW considers themselves to be confident and competent performing a skill is associated with externally rated application of that skill in practice. 20,21 However, in the subset analysis of training interactions, external ratings were lower than HCW's self-assessments, suggesting that confidence may not translate to objective competence.…”