ABSTRACT
The health care transition (HCT) from pediatric to adult care is a potential contributor to poor clinical outcomes among adolescents living with HIV (ALHIV). In sub-Saharan Africa (SSA), there is limited information on effective tools and processes to prepare and support ALHIV through this transition. This study elicited perspectives of policy-makers regarding barriers and facilitators to successful HCT among ALHIV in Kenya. Twenty in-depth interviews (IDIs) were conducted with policy-makers using a semi-structured guide. Using the socio-ecological model (SEM) as an organizing framework, directed content and thematic network analyses methods were used to characterize themes related to key influences on HCT processes and to describe actionable recommendations for improved tools and resources. Policy-makers identified multilevel support, including the development of a triadic relationship between the caregiver, healthcare worker (HCW) and adolescent, as an essential strategy for improved HCT success. Across the SEM, policy-makers described the importance of actively engaging adolescents in their care to promote increased ownership and autonomy over health decisions. At the structural level, the need for more comprehensive HCT guidelines and improved HCW training was highlighted. Expanded HCT tools and guidelines, that emphasize supportive relationships and intensified adolescent engagement, may improve HCT processes and outcomes.
Acknowledgements
We would like to thank study participants for their time and sharing their experiences, Kenneth Ondenge and Mary Gichuhi for their assistance with qualitative interviews, members of the ATTACH study team for assistance in collecting data, and our collaborating partners from the University of Nairobi, Kenyatta National Hospital, and the National AIDS and STI Control Program. GJS, DW, GO, INN, and KBS designed the study, data collection tools and oversaw data collection. CM, CM, JI and AO assisted with study coordination and data collection. KS and HA conducted analysis, with guidance from KBS and GO. KS, GO and KBS drafted the initial manuscript. All authors reviewed and approved the final manuscript.
Data availability statement
Data available upon request.
Disclosure statement
No potential conflict of interest was reported by the author(s).