Creating and Implementing a Tool to Predict Risk of HIV Care Disengagement in Adolescents in Western Kenya

summary

While in the Life and Health Sciences Internship, I was able to work in global health research, specifically focused on adolescent HIV care in western Kenya. The goal of this research is to better understand the challenges that result in adolescents disengaging from HIV care, as well as the factors that enable them to continue in care. This study is being done in collaboration with the Academic Model Providing Access to Healthcare (AMPATH), and includes interviews with healthcare workers in HIV clinics, and with adolescents and caregivers who have disengaged from HIV care. I read and analyze several interview transcripts, and I have helped organize excerpts from the interviews into categories of barriers and facilitators to care. These include factors related to the adolescent developmental stage, family contexts, the clinic setting and services, school factors, and issues in the wider community. This research will support the development of a tool to predict risk for adolescents disengaging from care, so that they can receive greater support. This work is done in order to ensure that adolescents being treated for HIV are supported to continue treatment despite complex barriers to care.

Background

  • As the leading cause of death for adolescents globally, HIV currently affects around 1.8 million adolescents, with 80% of them living in Sub-Saharan Africa
  • AMPATH (the Academic Model Providing Access to Healthcare) was created as the partnership between the IU School of Medicine and the Moi University School of Medicine in Eldoret, Kenya to provide HIV care services through care, research, and training
  • In order to prevent more people from being affected by HIV, it is necessary to retain those with HIV in care and avoid the further spread of infection

Goals

  • Identify barriers causing adolescents to disengage from care and find reasons why adolescents would stay in care
  • Use those findings to make improvements to the care program and be able to anticipate when adolescents are at risk for disengaging

methods

Dedoose

  • Helpful for mixed methods research and qualitative date analysis
  • Inter-Rater Reliability: a feature on that allows researchers to compare their analysis on the same excerpts

Covidence

  • A web-based program for systematic reviews
  • Steps of Systematic Review: initial screening, full text review, risk of bias assessment, extraction of study characteristics and outcomes, export of data and references

Results: barriers and facilitators:

Barriers and facilitators were organized into 5 main categories.

  1. Adolescent Development
        • Example: the experience of disclosure to the adolescent
  2. Family Context
        • Example: the presence of parents in the household
  3. Clinic Setting & Services
        • Example: having an adolescent-dedicated clinic
  4. School Factors
        • Example: stigma within peers
  5. Community Factors
        • Example: religious values in the community