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Ouedraogo P, Kanzyemo L, Razza R, Pietra V, Belemsobgom E, Schumacher RF. Transition of adolescents living with HIV from pediatric to adult care, a retrospective 12-year Single Center Study from the Sahel Region in West-Africa. AIDS Care 2024; 36:53-59. [PMID: 36942457 DOI: 10.1080/09540121.2023.2190955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
ABSTRACTTransition is the next major hurdle in the field of HIV-infected youth, especially in sub-Saharan Africa. At St Camille Hospital in Ouagadougou, fully informed and compliant patients over 13-years-old were eligible for referral to the adult HIV/AIDS service, after completion of an individualized preparatory process. Transition consisted in at least two consecutive "joined-service" appointments in the respective facilities. We retrospectively compared immunological, clinical, and therapeutical data one year before transition, at transition and one year after transition. Between 2008 and 2019 73 patients (34 females, 39 males) were transitioned. All had been previously in pediatric care for at least 1 year and 66 were on HAART. Matched paired analysis of CD4 counts revealed a modest drop in CD4 cells over time (p < 0.05). Clinical data also showed strong fluctuation between WHO clinical stages over the three time points, with a clear trend towards increased severity especially post transfer. This large retrospective 12-year single-center experience from a Sahel country showed a 95.8% retention rate at one year. It demonstrates how a comprehensive plan, carefully implemented, can provide excellent retention, even in a low-resource setting. However, mild immunological decline was associated with a worrisome clinical deterioration, underlining the importance of assessing the latter after transition.
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Affiliation(s)
- Paul Ouedraogo
- Pediatric HIV service, "Hôpital St Camille de Ouagadougou", Ouagadougou, Burkina Faso
| | - Lolita Kanzyemo
- Pediatric HIV service, "Hôpital St Camille de Ouagadougou", Ouagadougou, Burkina Faso
| | - Rossana Razza
- Pediatric HIV service, "Hôpital St Camille de Ouagadougou", Ouagadougou, Burkina Faso
- University Children's Hospital, "Ospedale dei Bambini", ASST Spedali Civili, Brescia, Italy
- Medicus Mundi Italy, Office of Ouagadougou, Ouagadougou, Burkina Faso
| | - Virginio Pietra
- Medicus Mundi Italy, Office of Ouagadougou, Ouagadougou, Burkina Faso
- Adult HIV service, "Hôpital St Camille de Ouagadougou", Ouagadougou, Burkina Faso
| | - Eric Belemsobgom
- Adult HIV service, "Hôpital St Camille de Ouagadougou", Ouagadougou, Burkina Faso
| | - Richard Fabian Schumacher
- University Children's Hospital, "Ospedale dei Bambini", ASST Spedali Civili, Brescia, Italy
- Medicus Mundi Italy, Office of Ouagadougou, Ouagadougou, Burkina Faso
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Improving Outcomes for Adolescents and Young Adults Living With HIV. J Adolesc Health 2023; 73:605-609. [PMID: 37422741 DOI: 10.1016/j.jadohealth.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
Adolescents and young adults living with HIV (AYLHIV), ages 10-24, experience inferior outcomes across the HIV care continuum compared to adults. Inferior outcomes are caused by clinical systems that are not tailored to AYLHIV, structural barriers that prevent equitable care, and lack of engagement of AYLHIV by care teams. This position paper outlines three recommendations to bridge these gaps in care outcomes. The first advocates for offering differentiated and integrated health services. The second addresses structural changes that can improve outcomes for AYLHIV. The third calls for actively including input from AYLHIV about the care designed for them.
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Wilson K, Agot K, Dyer J, Badia J, Kibugi J, Bosire R, Neary J, Inwani I, Beima-Sofie K, Shah S, Chakhtoura N, John-Stewart G, Kohler P. Development and validation of a prediction tool to support engagement in HIV care among young people ages 10-24 years in Kenya. PLoS One 2023; 18:e0286240. [PMID: 37390119 PMCID: PMC10313055 DOI: 10.1371/journal.pone.0286240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 05/11/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Loss to follow-up (LTFU) among adolescents and young adults living with HIV (AYALWH) is a barrier to optimal health and HIV services. We developed and validated a clinical prediction tool to identify AYALWH at risk of LTFU. METHODS We used electronic medical records (EMR) of AYALWH ages 10 to 24 in HIV care at 6 facilities in Kenya and surveys from a subset of participants. Early LTFU was defined as >30 days late for a scheduled visit in the last 6 months, which accounts for clients with multi-month refills. We developed a tool combining surveys with EMR ('survey-plus-EMR tool'), and an 'EMR-alone' tool to predict high, medium, and low risk of LTFU. The survey-plus-EMR tool included candidate sociodemographics, partnership status, mental health, peer support, any unmet clinic needs, WHO stage, and time in care variables for tool development, while the EMR-alone included clinical and time in care variables only. Tools were developed in a 50% random sample of the data and internally validated using 10-fold cross-validation of the full sample. Tool performance was evaluated using Hazard Ratios (HR), 95% Confidence Intervals (CI), and area under the curve (AUC) ≥ 0.7 for good performance and ≥0.60 for modest performance. RESULTS Data from 865 AYALWH were included in the survey-plus-EMR tool and early LTFU was (19.2%, 166/865). The survey-plus-EMR tool ranged from 0 to 4, including PHQ-9 ≥5, lack of peer support group attendance, and any unmet clinical need. High (3 or 4) and medium (2) prediction scores were associated with greater risk of LTFU (high, 29.0%, HR 2.16, 95%CI: 1.25-3.73; medium, 21.4%, HR 1.52, 95%CI: 0.93-2.49, global p-value = 0.02) in the validation dataset. The 10-fold cross validation AUC was 0.66 (95%CI: 0.63-0.72). Data from 2,696 AYALWH were included in the EMR-alone tool and early LTFU was 28.6% (770/2,696). In the validation dataset, high (score = 2, LTFU = 38.5%, HR 2.40, 95%CI: 1.17-4.96) and medium scores (1, 29.6%, HR 1.65, 95%CI: 1.00-2.72) predicted significantly higher LTFU than low-risk scores (0, 22.0%, global p-value = 0.03). Ten-fold cross-validation AUC was 0.61 (95%CI: 0.59-0.64). CONCLUSIONS Clinical prediction of LTFU was modest using the surveys-plus-EMR tool and the EMR-alone tool, suggesting limited use in routine care. However, findings may inform future prediction tools and intervention targets to reduce LTFU among AYALWH.
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Affiliation(s)
- Kate Wilson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jessica Dyer
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Jacinta Badia
- Impact Research and Development Organization, Kisumu, Kenya
| | - James Kibugi
- Impact Research and Development Organization, Kisumu, Kenya
| | - Risper Bosire
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Irene Inwani
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Seema Shah
- Northwestern University Medical School/Bioethics Program at Lurie Children’s Hospital, Chicago, IL, United States of America
| | - Nahida Chakhtoura
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Washington, DC, United States of America
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Child, Family, Population Health Nursing, University of Washington, Seattle, WA, United States of America
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Fomo MF, Newman J, Sibaya T, Ndlela N, Hussen S, Archary M, Zanoni BC. A qualitative assessment of the perceived acceptability and feasibility of eHARTS, a mobile application for transition readiness assessment for adolescents living with HIV in South Africa. PLOS DIGITAL HEALTH 2023; 2:e0000272. [PMID: 37327198 DOI: 10.1371/journal.pdig.0000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/08/2023] [Indexed: 06/18/2023]
Abstract
South Africa has the highest burden of adolescents living with HIV (ALHIV) in the world. The transition from pediatric to adult centered HIV care is a vulnerable period during which many clinical outcomes of ALHIV suffer. Transition readiness assessments may help ALHIV transition from pediatric to adult care to improve their health outcomes. Here, we evaluated the perceived acceptability and feasibility of a mobile health (mHealth) application, eHARTS, to determine transition readiness for ALHIV in South Africa. We conducted in-depth interviews with adolescents (n = 15) and healthcare providers (n = 15) at three government-supported hospitals in KwaZulu-Natal, South Africa. We used a semi-structured interview guide comprising of open-ended questions based on the unified theory of acceptance and use of technology. We did a thematic analysis of the data using an iterative, team-based coding approach to develop themes that were representative of the participants' perspectives on the acceptability and feasibility of eHARTS. We found that most participants found eHARTS to be acceptable because of its simplicity and lack of stigma. Participants believed eHARTS was feasible as it could easily be administered within a hospital setting and integrated into regular clinic activity without disrupting patient care. Additionally, eHARTS was found to have great utility for adolescents and healthcare providers. Clinicians saw it as a valuable tool to engage adolescents and prepare them for transition. Despite concerns that eHARTS may give adolescents a wrong impression about immediate transition, participants suggested that eHARTS be framed in an empowering way as they prepare for transition to adult care. Our data showed that eHARTS is a simple, mobile transition assessment tool with perceived acceptability and feasibility for use in HIV clinics in South Africa for ALHIV. It is particularly useful for ALHIV and transitioning to adult care as it can help identify gaps in readiness for transition.
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Affiliation(s)
- Messaline F Fomo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - John Newman
- Department of Medicine and Pediatric Infectious Diseases, Emory University, Georgia, United States of America
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Thobekile Sibaya
- Department of Pediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
| | - Nompumelelo Ndlela
- Department of Pediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
| | - Sophia Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine and Pediatric Infectious Diseases, Emory University, Georgia, United States of America
| | - Moherndran Archary
- Department of Pediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
| | - Brian C Zanoni
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine and Pediatric Infectious Diseases, Emory University, Georgia, United States of America
- Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
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Ashaba S, Zanoni BC, Baguma C, Tushemereirwe P, Nuwagaba G, Kirabira J, Nansera D, Maling S, Tsai AC. Challenges and Fears of Adolescents and Young Adults Living with HIV Facing Transition to Adult HIV Care. AIDS Behav 2023; 27:1189-1198. [PMID: 36129557 PMCID: PMC10027623 DOI: 10.1007/s10461-022-03856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/01/2022]
Abstract
Adolescents and young adults living with perinatally-acquired HIV (AYLPHIV) have poor outcomes along each step of the HIV care continuum due to challenges in seeking care and advocating for themselves. The transition from paediatric to adult HIV care is a particularly high-risk period for AYLPHIV in rural Uganda. We conducted in-depth interviews with AYLPHIV (n = 30), caregivers (n = 10), and healthcare providers (n = 10) to understand challenges facing AYLPHIV during the transition from paediatric to adult HIV care. Themes were identified by thematic content analysis. Transition-related challenges and fears included difficulty navigating the adult HIV clinic; loss of informational support; long wait times at the adult HIV clinic; lack of privacy, and fear of HIV status disclosure and stigma; and loss of support from caregivers, and health care providers. Before transitioning to adult HIV care, AYLPHIV should be adequately prepared and given appropriate information to help them navigate adult HIV care.
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Affiliation(s)
- Scholastic Ashaba
- Mbarara University of Science and Technology, Plot 8-18, P. O.BOX 1410, Mbarara, Uganda.
| | - Brian C Zanoni
- Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, USA
- Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Charles Baguma
- Mbarara University of Science and Technology, Plot 8-18, P. O.BOX 1410, Mbarara, Uganda
| | | | - Gabriel Nuwagaba
- Mbarara University of Science and Technology, Plot 8-18, P. O.BOX 1410, Mbarara, Uganda
| | | | - Denis Nansera
- Mbarara University of Science and Technology, Plot 8-18, P. O.BOX 1410, Mbarara, Uganda
| | - Samuel Maling
- Mbarara University of Science and Technology, Plot 8-18, P. O.BOX 1410, Mbarara, Uganda
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Plot 8-18, P. O.BOX 1410, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Njuguna IN, Beima-Sofie K, Mburu CW, Mugo C, Itindi J, Onyango A, Neary J, Richardson BA, Oyiengo L, Wamalwa D, John-Stewart G. Transition to independent care for youth living with HIV: a cluster randomised clinical trial. Lancet HIV 2022; 9:e828-e837. [PMID: 36309040 PMCID: PMC10308660 DOI: 10.1016/s2352-3018(22)00244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND Transitioning youth living with HIV to adult care is a crucial step in the HIV care continuum; however, tools to support transition in sub-Saharan Africa are insufficient. We assessed the effectiveness of an adolescent transition package (ATP) to improve youth readiness for transition to independent HIV care. METHODS In this hybrid type 1, multicentre, cluster randomised clinical trial, we assessed the effectiveness of an ATP (administered by routine clinic staff, which included standardised assessments and chapter books to guide discussions at scheduled clinic visits) in four counties in Kenya, with HIV clinics randomly assigned 1:1 to ATP or control (standard-of-care practice). Clinics were eligible to participate if they had at least 50 youth (aged 10-24 years) living with HIV enrolled in care. We used restricted randomisation to achieve cluster balance and an independent biostatistician used computer-generated random numbers to assign clinics. We excluded very large clinics with more than 1000 youth, clinics with fewer than 50 youth, paediatric-only clinics, clinics with logistical challenges, and the smallest clinics in Homa Bay county. Youth were eligible for the transition intervention if they were enrolled in participating clinics, were aged 15-24 years, and were aware of their positive HIV diagnosis. Study staff assessed transition readiness scores overall and by four domains (HIV literacy, self-management, communication, and support) in youth with HIV, which were then compared between groups by use of mixed-effects linear regression models. Analysis was by intention-to-treat and was adjusted for multiple comparisons. This trial is registered with ClinicalTrials.gov, NCT03574129. FINDINGS We identified 35 clinics in four counties; of these, ten were assigned to the intervention group and ten to the control group. Of 1066 youth with HIV enrolled between Nov 1, 2019, and March 18, 2020, 578 (54%) were in intervention and 488 (46%) in control sites. Mean baseline transition readiness score was 12·1 (SD 3·4) in ATP sites and 11·4 (3·7) in control sites. At 1 year, adjusting for baseline scores, age, and months since HIV disclosure, participants in the ATP group had significantly higher overall transition readiness scores (adjusted mean difference 1·7, 95% CI 0·3-3·1, p=0·024), and higher scores in HIV literacy domain (adjusted mean difference 1·0, 0·2-1·7, p=0·011). At 12 months, 15 serious adverse events were recorded, none of which were thought to be related to study participation. INTERPRETATION Integrating ATP approaches could enhance long-term HIV care in youth with HIV as they age into adulthood. FUNDING US National Institutes of Health.
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Affiliation(s)
- Irene N Njuguna
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, WA, USA.
| | | | - Caren W Mburu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Janet Itindi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Laura Oyiengo
- Neonatal and Child Health Services, Ministry of Health, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
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Agambire R, Mchunu GG, Naidoo JR. Adolescent on the bridge: Transitioning adolescents living with HIV to an adult clinic, in Ghana, to go or not to go? PLoS One 2022; 17:e0273999. [PMID: 36173996 PMCID: PMC9522288 DOI: 10.1371/journal.pone.0273999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Children survive into adult life with Human Immunodeficiency Virus (HIV), which previously would have been lethal in early childhood. Methods The study aimed to describe the current transitional process for Adolescents Living with HIV (ALHIV) in a resource-limited setting in Ashanti Region, Ghana. The study was an explorative study that used an interpretive paradigm. A semi-structured interview guide was used to interview ALHIV, selected by purposive sampling. The study was conducted at a tertiary hospital in Kumasi. Data were analysed using thematic analysis. Results Transitioning of ALHIV was done without any guide; the themes generated were on the process of transition in which they used age (13 and above) and disclosure as the criterion to move ALHIV to the adult clinic. Most adolescents complained about being stigmatised, the attitude of staff, interruption of school and separation anxiety as experiences they went through during the transitioning process. On improving transition, ALHIV felt sexual and reproductive health services, information on treatment, privacy, and support were necessary transition components. Conclusion The use of age and disclosure of status as a criterion for transitioning ALHIV affects moving and retaining this age group in HIV management programs in the adult clinics. There is, therefore, an urgent need for a guideline as the current transition process defeats the purpose of providing adolescents with age-specific care in the Adult Clinic.
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Affiliation(s)
- Ramatu Agambire
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, South Africa
- Department of Nursing, Faculty of Health Sciences, Garden City University College, Kumasi, Ghana
- * E-mail:
| | - Gugu G. Mchunu
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Joanne R. Naidoo
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Eastern Cape, South Africa
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Development of a transition readiness score for adolescents living with perinatally-acquired HIV and transitioning to adult care. AIDS Behav 2022; 26:3131-3138. [PMID: 35362907 PMCID: PMC9372012 DOI: 10.1007/s10461-022-03650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/01/2022]
Abstract
We created a transition readiness score for adolescents with perinatally-acquired HIV as they transition from pediatric to adult care. Of the 199 adolescents who transitioned to adult care, 84 (42%) had viral suppression (< 200 copies/ml) one year after transition. Adolescents on first-line ART, with documented HIV status disclosure, and higher rating on the HIV Adolescent Readiness to Transition Scale had significantly higher odds of viral suppression after transition. Conversely, females, those with older age at ART initiation, and those with prior alcohol use had significantly lower odds of viral suppression after transition. Using these data, we created a transition readiness score organized into low, intermediate, and high levels of transition readiness. This transition readiness score can be used to identify adolescents who are likely ready to transition to adult care and identify additional areas for intervention to improve the likelihood of successful transition for those with lower transition readiness scores.
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Zanoni BC, Archary M, Sibaya T, Goldstein M, Bergam S, Denton D, Cordero V, Peng C, Psaros C, Marconi VC, Haberer JE. Mobile Phone-Based Intervention Among Adolescents Living With Perinatally Acquired HIV Transitioning from Pediatric to Adult Care: Protocol for the Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA) Study. JMIR Res Protoc 2022; 11:e35455. [PMID: 35060907 PMCID: PMC8817214 DOI: 10.2196/35455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Adolescents living with perinatally acquired HIV often have poor retention in care and viral suppression during the transition from pediatric to adult-based care. OBJECTIVE The aim of this study is to evaluate a mobile phone-based intervention, Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA), among adolescents living with perinatally acquired HIV as they transition from pediatric to adult care in South Africa. METHODS InTSHA uses encrypted, closed group chats delivered via WhatsApp (Meta Platforms Inc) to develop peer support and improve communication between adolescents, their caregivers, and health care providers. The intervention is based on formative work with adolescents, caregivers, and health care providers and builds on several existing adolescent support programs as well as the Social-ecological Model of Adolescent and Young Adult Readiness for Transition (SMART). The final InTSHA intervention involves 10 modules conducted weekly through moderated WhatsApp group chats with adolescents and separately with their caregivers. We will randomly assign 80 South African adolescents living with perinatally acquired HIV who are aware of their HIV status and aged between 15 and 19 years to receive either the intervention (n=40) or standard of care (n=40). RESULTS We will measure acceptability of the intervention as the primary outcome and evaluate feasibility and preliminary effectiveness for retention in care and viral suppression after completion of the intervention and at least 6 months after randomization. In addition, we will measure secondary outcomes evaluating the impact of the InTSHA intervention on peer support, self-esteem, depression, stigma, sexual education, connection to health care providers, and transition readiness. Enrollment began on April 15, 2021. As of December 31, 2021 a total of 78 out of expected 80 participants have been enrolled. CONCLUSIONS If successful, the intervention will be evaluated in a fully powered randomized controlled trial with a larger number of adolescents from urban and rural populations to further evaluate the generalizability of InTSHA. TRIAL REGISTRATION ClinicalTrials.gov NCT03624413; https://clinicaltrials.gov/ct2/show/NCT03624413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35455.
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Affiliation(s)
- Brian C Zanoni
- School of Medicine, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Moherndran Archary
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- King Edward VIII Hospital, Durban, South Africa
| | - Thobekile Sibaya
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Madeleine Goldstein
- School of Medicine, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Scarlett Bergam
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- King Edward VIII Hospital, Durban, South Africa
| | - David Denton
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Vincente Cordero
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cynthia Peng
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Christina Psaros
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Vincent C Marconi
- School of Medicine, Emory University, Atlanta, GA, United States
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jessica E Haberer
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
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