scholarly journals Multilevel Factors Underlying Adolescent Retention and Disengagement in HIV Care

2020 ◽  
Vol 3 ◽  
Author(s):  
Nathan Risk ◽  
Judith Toromo ◽  
Chelsea Misquith ◽  
Leslie Enane
Keyword(s):  
Policy Implications ◽  
Barriers And Facilitators ◽  
Hiv Care ◽  
Care Providers ◽  
Hiv Status ◽  
Travel Costs ◽  
Retention In Hiv Care ◽  
Full Text Review ◽  
Anticipated Stigma ◽  
Living With Hiv

Background/Objective: Adolescents (ages 10-19) living with HIV are at risk for disengagement from HIV care, resulting in poor health and potential for viral transmission. It is important to uncover the central barriers that result in adolescents becoming disengaged from care in order to develop interventions or models to support adolescent retention. We sought to investigate the multilevel barriers and facilitators to adolescent retention in HIV care.    Methods: A systematic search was performed to identify relevant studies from 1994 onwards, both qualitative and quantitative, in any language, and in all geographic regions. Title and abstract screening identified relevant articles. A full text review determined final inclusion. Key variables were extracted, focused on the range of multilevel barriers and facilitators to retention, and any differences according to population or setting. Preliminary findings are summarized.    Results: Quantitative factors associated with disengagement include: older adolescence, racial or ethnic minority status, family-level poverty, and receiving care at a rural clinic. Qualitative barriers to retention include: distance to the clinic and associated travel costs, psychosocial challenges and lack of support for them, anticipated stigma with inadvertent disclosure of HIV status, nondisclosure of HIV status to both the adolescent and family members, negative experiences with care providers, challenges requesting absence from school, and negative school environments. Facilitators to retention include: having strong social support, having a family member with HIV, having positive relationships with providers and clinic staff, attending an adolescent-dedicated clinic or a clinic with adolescent-dedicated hours, having access to intensive counseling, and having access to peer groups/peer mentors.     Conclusion and Policy Implications: Improving adolescent retention requires addressing the multilevel factors that lead to disengagement. Interventions with potential to mitigate against the range of challenges adolescents face are needed to support adolescents to overcome these challenges and continue in life-long HIV care. 

scholarly journals Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986821
Author(s):  
Claire E. Kendall ◽  
Janessa E. Porter ◽  
Esther S. Shoemaker ◽  
Rachel Seoyeon Kang ◽  
Michael Fitzgerald ◽  
...  
Keyword(s):  
At Risk ◽  
Primary Care Providers ◽  
Question Type ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Local Health ◽  
Care Providers ◽  
Patients At Risk ◽  
Survey Responses ◽  
Living With Hiv

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

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

2020 ◽  
Vol 19 ◽  
pp. 232595822093526
Author(s):  
Elizabeth Karman ◽  
Kate S. Wilson ◽  
Cyrus Mugo ◽  
Jennifer A. Slyker ◽  
Brandon L. Guthrie ◽  
...  
Keyword(s):  
Health Care ◽  
Work Experience ◽  
Hiv Care ◽  
Care Providers ◽  
Care Workers ◽  
Competence Training ◽  
Expert Input ◽  
Living With Hiv ◽  
Care Worker ◽  
Youth Friendly

Lack of health care worker (HCW) training is a barrier to implementing youth-friendly services. We examined training coverage and self-reported competence, defined as knowledge, abilities, and attitudes, of HCWs caring for adolescents living with HIV (ALWH) in Kenya. Surveys were conducted with 24 managers and 142 HCWs. Competence measures were guided by expert input and Kalamazoo II Consensus items. Health care workers had a median of 3 (interquartile range [IQR]: 1-6) years of experience working with ALWH, and 40.1% reported exposure to any ALWH training. Median overall competence was 78.1% (IQR: 68.8-84.4). In multivariable linear regression analyses, more years caring for ALWH and any prior training in adolescent HIV care were associated with significantly higher self-rated competence. Training coverage for adolescent HIV care remains suboptimal. Targeting HCWs with less work experience and training exposure may be a useful and efficient approach to improve quality of youth-friendly HIV services.

scholarly journals Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind

2020 ◽  
Vol 17 (5) ◽  
pp. 458-466
Author(s):  
Anna Grimsrud ◽  
Lynne Wilkinson ◽  
Ingrid Eshun-Wilson ◽  
Charles Holmes ◽  
Izukanji Sikazwe ◽  
...  
Keyword(s):  
Quality Care ◽  
Treatment Interruption ◽  
Patient Choice ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Engagement In Care ◽  
Hiv Status ◽  
Hiv Care Cascade ◽  
Left Behind ◽  
Living With Hiv

Abstract Purpose of Review Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. Recent Findings There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. Summary There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.

scholarly journals Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial

10.2196/24043 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e24043
Author(s):  
Kathryn Elizabeth Muessig ◽  
Jesse M Golinkoff ◽  
Lisa B Hightow-Weidman ◽  
Aimee E Rochelle ◽  
Marta I Mulawa ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
Hiv Status ◽  
Mhealth Intervention ◽  
Sex With Men ◽  
The University ◽  
Living With Hiv ◽  
Hiv Negative

Background Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. Objective Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care–related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. Methods We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. Results Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. Conclusions Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. Trial Registration ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. International Registered Report Identifier (IRRID) DERR1-10.2196/24043

scholarly journals Retention in HIV Care among Children Aged 0-14 Years and the Associated Family and Caregiver Factors in Embu County, Kenya

2021 ◽  
Vol 11 (7) ◽  
pp. 293-302
Author(s):  
Ikiara, Eliza Kathure ◽  
Orinda, George Owino ◽  
Thigiti, Joseph Mwangi
Keyword(s):  
Retention In Care ◽  
Cross Sectional Study ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Cross Sectional ◽  
Number Of Factors ◽  
Retention In Hiv Care ◽  
The Family ◽  
Associated Family

Background: Retention of children in HIV care is influenced by a number of factors, among them family and caregiver factors. Objective: To determine the family and caregiver factors associated with retention in care. Methods: We conducted a cross sectional study in level 4 and 5 hospitals in Embu county. Data were collected through interviews using a predesigned questionnaire. Descriptive and inferential data analysis was performed. Results: We enrolled 238 participants between January and April 2018, comprising 143 males (50.5%) and 140 females (49.5%). The median age of the participants was 12 years (IQR 5). Two thirds of the minors were in primary school (192, 67.8%). More of the children’s mothers were HIV positive compared to the fathers (257 vs 99) though a greater number of the fathers had an unknown HIV status compared to the mothers (138 vs 21). Most minors (241, 85.2%) were retained in care throughout having never missed an appointment. The number of siblings alive (aOR 0.72, 95% CI: 0.56, 0.92), siblings with HIV (aOR 0.26, 95% CI: 0.10, 0.68), a HIV positive caregiver (aOR 5.48, 95% CI: 2.44, 12.97), stigma (aOR 0.35, 95% CI: 0.15, 0.77), work duties of the caregiver (aOR 0.28, 95% CI 0.13, 0.58) and denial of HIV status by the caregiver (aOR 0.10, 95% CI 0.02, 0.47) were all associated with retention in HIV care. Conclusion: A HIV positive caregiver was most likely to ensure a child is retained in care. Stigma and denial of HIV status still hinder retention. Key words: Retention, HIV, children, caregiver.

scholarly journals ‘There are no more secrets’: acceptability of a family-centered model of care for HIV positive children in Eswatini

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Philisiwe N. Khumalo ◽  
Leila Katirayi ◽  
Kim Ashburn ◽  
Caspian Chouraya ◽  
Lydia Mpango ◽  
...  
Keyword(s):  
Waiting Times ◽  
Family Members ◽  
Standard Of Care ◽  
Antiretroviral Drugs ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Retention In Hiv Care ◽  
Family Centered ◽  
Clinic Visits

Abstract Background HIV-positive children have lagged adults on retention in HIV care and viral suppression. To address this gap, Eswatini’s Ministry of Health started a pilot family-centered HIV care model (FCCM) targeting HIV-positive children under 20 years old and their families. Methods We conducted semi-structured in-depth interviews with 25 caregivers and 17 healthcare workers (HCWs) to assess acceptability of FCCM in four pilot FCCM health facilities in Hhohho region of Eswatini. Thematic analysis with inductive and deductive codes was used to identify salient themes. Results Caregivers and HCWs reported FCCM benefits including strengthening the family bond, encouragement for family members to disclose their HIV status and supporting each other in taking antiretroviral drugs. Caregivers reported that they spent fewer days in clinic, experienced shorter waiting times, and received better counseling services in FCCM compared to the standard-of-care services. FCCM implementation challenges included difficulty for families to attend clinic visits together (e.g., due to scheduling conflicts with weekend Teen Support Club meetings and weekday FCCM appointments). Both HCWs and caregivers mentioned difficulty in sharing sensitive health information in the presence of other family members. HCWs also had challenges with supporting caregivers to disclose HIV status to children and managing the larger group during clinic visits. Conclusions FCCM for HIV-positive children was acceptable to both caregivers and HCWs, and they supported scaling-up FCCM implementation nationally. However, special considerations should be made to address the challenges experienced by participants in attending clinic visits together as a family in order to achieve the full benefits of FCCM for HIV positive children.

Sign in / Sign up

Export Citation Format

Share Document