Transitioning from pediatric to autonomous adult care is a vulnerable period when many adolescents drop out of HIV treatment programs. In contrast to trends in adult HIV infection where mortality is decreasing, rates of mortality among infected adolescents are increasing in many settings, underscoring the need for improved transitional care. Standardized transition tools, such as the US-based Got Transition model, have been developed to help children, caregivers, and providers plan for and execute transition across diverse chronic diseases; these tools are effective, and widely utilized in the US. However, transition tools are largely untested in settings with high HIV prevalence, and there are few systematic approaches to transition being used in Africa. Furthermore, effective transition can only occur alongside HIV disclosure, which can be delayed due to caregiver concerns about coping, guilt, or inadvertent loss of confidentiality. Transitional care and pediatric HIV disclosure are complementary urgent priorities for adolescents with HIV. We propose to adapt the Got Transition tool for use in Kenya where we have previously observed low rates of retention and disclosure among adolescents. We will utilize nationwide electronic medical records (KenyaEMR) to determine rates of successful transition in existing youth treatment programs, and determine predictors of successful transition (Aim 1). We will conduct interviews with adolescents, caregivers, healthcare workers and policy-makers to inform adaptation of the Got Transition tool for use in Kenya (Aim 2). Finally, we will test a combined intervention package consisting of the adapted transition tool plus a previously validated disclosure tool in a cluster randomized trial (Aim 3). This proposal builds on a >25 year HIV research collaboration between the University of Washington, the University of Nairobi, and the Kenya National AIDS/STI Control Programme (NASCP). Our collaboration with NASCOP enables us to conduct research that is impactful, locally relevant, and aligned with national programmatic approaches to facilitate implementation at scale. Adapting the established Got Transition model for use in Kenya and combining this with the disclosure toolkit is an efficient approach to address the continuum between pediatric to adult HIV care, and is expected to result in a novel product that can be implemented nationally. The study will additionally provide important evidence for a generalizable approach to improve disclosure and transition for adolescents with HIV infection throughout Africa.
Transitioning from pediatric to adult HIV care is a particularly vulnerable time in which many adolescents drop out of care and stop taking their drugs; programmatic improvements to improve and increase rates of retention, adherence, and disclosure have the potential to improve both proximal and lifetime outcomes for HIV-infected adolescents. The proposed study will determine predictors of successful transition and will test an intervention aimed at improving rates of effective disclosure and transition.