In 2013, AIDS was the leading cause of mortality among adolescents in sub-Saharan Africa (SSA). Research has shown that mortality among adolescents increases with transfer from pediatric to adult care due to poor retention in care, low viral suppression and poor psychosocial wellbeing. Majority of these deaths occurred in SSA. Few countries in SSA have an evidence-based protocol to transition ALHIV from pediatric to adult care. Nigeria has an estimated 160, 000 to 200,000 adolescents living with HIV (ALHIV), making it the country with the 2nd highest burden of HIV. In 2013, Nigeria accounted for ~10% of the deaths, with an estimated 11,000 AIDS-related deaths among adolescents. While previous national policy documents in Nigeria have recognized HIV among adolescents as an issue, none of these documents provide a comprehensive policy on ALHIV and none has any focus on transition of care. Nigeria is one of 25 target countries identified by the UNAIDS, UNICEF and partners in the ?All in to End Adolescent AIDS? initiative. ?All In? focuses on adolescents as part of the fast- track goals to end the HIV epidemic by 2030. The proposed research is designed to identify feasible, acceptable and sustainable approaches to transition ALHIV from pediatric to adult care. It is timely, as the Federal Ministry of Health and partners are working on finalizing a strategy for adolescents and young people living with HIV in Nigeria. Our proposed cluster randomized trial will test the comparative effectiveness of an Adolescent Coordinated Transition (ACT) program (Intervention Group; IG) versus the standard of care that abruptly transfers adolescents to adult care (Control Group, CG), on retention in care, viral suppression and psychosocial wellbeing among 216 HIV-infected Nigerian adolescents. Twelve healthcare facilities from all six geo-political zones will be randomly assigned (1:1) to IG or CG. ACT is a combination of a graduated transition program plus a pre-and post-transition peer-led Organized Support Group. The primary outcome is post-transition retention in care among ALHIV. Secondary outcomes are the difference among the groups in viral suppression rates and psychosocial wellbeing measured by improvement in perceived mental health status and the shift from external to internal health locus of control. This proposal is a collaboration among five members of the Nigeria Implementation Science Alliance (NISA) that currently serve nearly 25,000 ALHIV across all 36 states in Nigeria. NISA members have expertise in the implementation of nationally-supported programs for people living with HIV in Nigeria. Collaborators includes: Institute of Human Virology Nigeria; Family Health International 360, AIDS Prevention Initiative in Nigeria, Center for Clinical Care and Clinical Research Nigeria, and Center for Integrated Health Programmes (local program implementation and coordination); Nevada State College (statistical analyses and mediation/moderation analysis), and University of Nevada, Las Vegas (overall oversight of program implementation and evaluation).
STATEMENT Although AIDS-related deaths fell by 30% among people living with HIV from 2005 to 2012, mortality increased by 50% among adolescents living with HIV with 92% of these deaths occurring in sub-Saharan Africa. An estimated 160,000 to 200,000 adolescents are living with HIV in Nigeria with few organizations having a clear strategy in place to transition these adolescent from pediatric to adult care, and few models of successful transition of care have been demonstrated to be feasible, acceptable and sustainable in resource-limited settings. Using a cluster randomized trial design among 216 adolescents living with HIV in 12 healthcare facilities in Nigeria, the proposed study aim to evaluate the comparative effectiveness of an Adolescent Coordinated Transition (ACT) program that combines a transition period with peer-led organized support group compared to usual care that transfers adolescents to adult care without a transitional period on retention, viral suppression and psychosocial wellbeing.
| Badejo, Okikiolu A; Menson, William N A; Sam-Agudu, Nadia A et al. (2018) Pediatric to adult healthcare transitioning for adolescents living with HIV in Nigeria: A national survey. PLoS One 13:e0198802 |
| Sam-Agudu, Nadia A; Pharr, Jennifer R; Bruno, Tamara et al. (2017) Adolescent Coordinated Transition (ACT) to improve health outcomes among young people living with HIV in Nigeria: study protocol for a randomized controlled trial. Trials 18:595 |
