Implementation of a readiness assessment tool to support the transition of adolescents living with HIV to adult care in Kenya


BACKGROUND: Tools assessing the transition from child-centred to adult care can improve outcomes among youth living with HIV (YLH). Within an ongoing clinical trial (Adolescent Transition to Adult Care for HIV-infected Adolescents in Kenya ' ATTACH) evaluating the effectiveness of an Adolescent Transition Package (ATP), we determined experiences of clinic-based study staff who administered a transition readiness assessment tool.
METHODS: Between January and March 2021, we conducted semi-structured interviews with ten research staff who administered a transition readiness assessment to 1066 YLH (ages 14-24) enrolled in the ATTACH study. The ATP was delivered to YLH by existing health care workers physically and later by phone during the Covid 19 pandemic. The effectiveness outcome &transition readiness was assessed by study staff. The tool included a combination of open-ended and rubric questions. Interviews were audio-recorded, transcribed, converted into structured debrief reports. We utilized thematic analysis grounded in the RE-AIM (Reach, Effectiveness, Adoption, Implementation Maintenance) framework, to identify attributes impeding or facilitating assessment of transition readiness.
RESULTS: Participants described rapport building with YWH, access to private spaces, and supportive facility staff as critical in optimizing reach. Shifting to phone delivery of the assessment during COVID-19 negatively affected reach, limiting access to YLH lacking consistent phone access. Participants perceived the tool to be adequate in assessing transition readiness. YLH engaged in facility support groups, had family social support & had received early disclosure performed better. Males often had not disclosed to partners and had little knowledge on sexual and reproductive health compared to females. Most YLH struggled with remembering antiretroviral names and understanding viral load cut-off measures. Questions about sensitive topics, such as disclosure and sexual and reproductive health topics, were most challenging to ask. Participants recommended standardized rubrics for open-ended questions on HIV literacy and strategies for asking sensitive questions. Incorporation of the tool within patient encounter forms and leveraging peer educators to address overwhelmed clinic staff were described as potential strategies for adoption of the tool.
CONCLUSIONS: Integration into routine clinic settings of the transition assessment tool will require optimization to include rubrics for grading open-ended responses and incorporation into routine clinic tools.

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