November 27, 2024

Researchers awarded new grant to test implementation strategies to scale-up transitional care among youth living with HIV in Kenya

As more children and adolescents living with HIV survive into adulthood, maintaining successful and uninterrupted transitions into adult HIV care clinics has become a priority in the HIV/AIDS research community.  Adolescents having “grown up” under pediatric HIV care may experience deep loss of their support system and feel less prepared to assume responsibility for themselves in adult care.  The transition is a vulnerable point when adolescents are at risk of disengagement from HIV care altogether.  It is critical that they maintain uninterrupted HIV care to stay healthy, maintain low viral load, and reduce further transmission.

Since 2016, Global WACh investigators Drs. Irene Njuguna, Kristin Beima-Sofie, Grace John-Stewart, and Dalton Wamalwa have led efforts to engage the Ministry of Health and local communities in Kenya in the development of the Adolescent Transition Package (ATP), a healthcare worker toolkit that includes structured educational materials and tracking tools to facilitate the transition process.

Their research team recently tested the ATP in a cluster randomized clinical trial of nearly 1,000 youth living with HIV in 20 clinics in Kenya and found the tool effective at improving transition readiness. It was acceptable to those delivering and receiving the tool, feasible to implement, and low cost.  Following the release of favorable trial results, there is a desire among health officials, community members, and other key stakeholders to scale up the ATP across Kenya using the optimal implementation strategies.

With support from a newly awarded National Institute of Mental Health grant, the Global WACh investigators and research teams at UW and Kenyatta National Hospital aim to identify the best approach by comparing two evidence-based implementation strategies – one that incorporates conventional cascading training of trainers (refers to training a small group of expert trainers on a topic, who then train a large group, who in turn train a larger group, creating a “cascade” effect) and the other that includes youth-led evaluation and adaptation processes – to improve ATP implementation.

By investigating these strategies at the inception of scale-up, the research team has an opportunity to inform best practices for expanded national scale-up that could apply not only in Kenya but in other regions as well.  We look forward to sharing future updates on their work.