Health provider training is associated with improved engagement in HIV care among adolescents and young adults in Kenya
| Autor: | Margaret Nduati, Grace John-Stewart, Cyrus Mugo, David Bukusi, Hellen Moraa, Dalton Wamalwa, Alvin Onyango, Pamela Kohler, Jennifer A. Slyker, Brandon L. Guthrie, Irene Inwani, Barbra A. Richardson, Kate Wilson |
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| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Kenya Adolescent Immunology Psychological intervention HIV Infections Article law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Behavior Therapy law Humans Immunology and Allergy Medicine 030212 general & internal medicine Young adult Child Health Education Retrospective Studies business.industry Medical record Retrospective cohort study humanities Checklist 3. Good health 030104 developmental biology Infectious Diseases Relative risk Family medicine Patient Compliance business Delivery of Health Care |
| Zdroj: | AIDS |
| ISSN: | 0269-9370 |
| DOI: | 10.1097/qad.0000000000002217 |
| Popis: | 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 study. Methods 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. Multilevel regression estimated risk ratios 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. Results Among 3662 AYA records at first eligible visit, most were female (75.1%), older (20-24 years: 54.5%), and on antiretroviral therapy (79.5%). Overall, 2639 AYA returned for care (72.1%) after enrollment or re-engagement visit. Engagement in care among AYA was significantly higher at facilities offering provider training in adolescent-friendly care (85.5 vs. 67.7%; adjusted risk ratio (aRR) 1.11, 95% CI: 1.01-1.22) and that used the Kenyan government's AYA care checklist (88.9 vs. 69.2%; aRR 1.14, 95% CI: 1.06-1.23). Engagement was also significantly higher at facilities where providers reported being trained in AYA HIV care (aRR 1.56, 95% CI: 1.13-2.16). Conclusion Adolescent-specific health provider training and tools may improve quality of care and subsequent AYA engagement. Health provider interventions are needed to achieve the '95-95-95' targets for AYA. |
| Databáze: | OpenAIRE |
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