Identifying gaps in adolescent HIV care and treatment delivery in Asia: results of a regional health provider survey

ABSTRACT

Adolescents living with HIV (ALHIV) have substantial challenges accessing and adhering to HIV care and antiretroviral therapy (ART). We conducted a study to gather data on clinical service practices to support ALHIV-focused care in Asia using a 31-question survey for healthcare providers on care and treatment services, support for adherence and retention, and tracking of risk behaviors. It was generated in Google Forms, available in seven languages (Bahasa Indonesia, Chinese Mandarin, English, Malay, Khmer, Thai, Vietnamese), and hosted via Google Drive. Survey request emails were distributed to individual stakeholders (e.g. HIV clinicians, researchers, policymakers), and via sector listserves. Survey completion denoted consent to participate. Descriptive statistics with median values are provided. Between December 2015 and May 2016, 82 respondents from Cambodia (17%), China (6.1%), India (3.6%), Indonesia (20%), Malaysia (12%), Thailand (23%), and Vietnam (18%) participated. Most were physicians (73%) from tertiary-level hospitals (66%); 16% reported caring for >100 patients, 42% for 21–100, and 31% for <20; 95% of ALHIV in their care were on ART, 20% were on a second-line regimen. ALHIV-specific services were offered by less than half of the respondent clinics, and included 22% with designated adolescent care providers, and 19% with adolescent clinic times. Transition preparation included how to navigate adult care services (82%) and communicate with new health providers (67%), and some used a multidisciplinary team of pediatric and adult providers to coordinate transition (35%). Their most commonly reported challenges in ALHIV care included socio-economic limitations impacting care uptake (e.g. transportation, food insecurity; 44%), difficulty supporting self-disclosure by the adolescent (44%), and poor ART adherence (42%). These study results highlight the variable scope of HIV care offered by pediatric HIV centers to ALHIV in Asia, as well as challenges with service delivery, social support, and engaging adult HIV providers in the transition preparation process.

KEYWORDS:

• HIV
• adolescent
• adherence
• retention
• transition
• Asia

Acknowledgments

The authors would like to thank Martina Penazatto, Alice Armstrong, and Jane Ferguson for their feedback on the survey tool. The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense.

Disclosure statement

Pharma Company as a potential conflict of interest was reported by the authors.

Supplemental data

Supplemental data for this paper can be accessed on the publisher’s website.

Additional information

Funding

The study was conducted with funding from ViiV Healthcare through the Positive Action for Adolescents Program.