Adolescent HIV Care and Treatment in Uganda: Care Models, Best Practices and Innovations to Improve Services

Asire, Barbara; Nabukeera-Barungi, Nicolette; Elyanu, Peter; Katureebe, Cordelia; Lukabwe, Ivan; Namusoke, Eleanor; Musinguzi, Joshua; Tumwesigye, Nazarius Mbona; Atuyambe, Lynn

doi:10.4172/2329-8731.1000150

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…Asire and colleagues [12] assessed both private and public clinics in Uganda caring for YPLHIV and found that only 3% of healthcare facilities had a speci c health transition clinic (HTC) to support the transition from paediatric providers to adult providers. Additionally, Nyabigambo and colleagues [13]found that HTC use is less common in those who are older (age 20-24), male, live in rural locations, acquired HIV behaviorally, are not on antiretroviral therapy (ART), and have CD4 counts > 250.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: Unintended consequences of successful adolescent ART clinics

Mbalinda

Bakeera-Kitaka

Amooti

et al. 2020

Preprint

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BackgroundThere is a growing number of adolescents and young adults with HIV who require transfer of care from pediatric/ adolescent clinics to adult ART clinic. Currently, adolescents are largely in the care of pediatricians; but as they grow, they transition to adult HIV clinics. The purpose of this study was to explore the facilitators and barriers of transitioning among adolescents from adolescent clinics to adult ART clinics.MethodAn explorative qualitative approach was utilised for this study. Eighteen focus group discussions were held in nine health facility with (191) adolescents and young people in order to capture their experiences, barriers and facilitators regarding transitioning to adult clinics. The focus group discussions were audio recorded and transcribed. The Silences Framework using thematic approach guided the analysis.Results The key emerging issues were: Care provided in the adolescent clinics, Unfriendly adults, stigma and discrimination, Congestion and long waiting time, health providers in adult clinics were barriers to transitioning. Moving as a cohort, Transition preparation, care in clinics, positive living, support from the guardian and Young adolescent program Support (YAPS) could facilitate readiness and transitioning.ConclusionAdolescents and young people expressed fear to transition to adult clinics mainly because of the perceived better care provided in adolescent clinic, thus constituting a barrier to smooth transition A range of individual, social and health system and services-related factors hindered transitioning. Expectation of transitioning as a group, assurance of similar care as in the adolescent clinic, and guarantees of confidentiality, privacy and autonomy in decision-making for care were perceived as facilitators. There is need to strengthen implementation of age-appropriate care and individualized case management during care transition at all health facilities. Furthermore, the findings suggest the need to create supportive family, peer, and healthcare environments for adolescent transition.

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Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: Unintended consequences of successful adolescent ART clinics

Mbalinda

Bakeera-Kitaka

Amooti

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…An explorative qualitative approach was utilised for this study using eighteen (18) focus group discussions. Data was collected from 9 health facilities in all the four regions of Uganda.…”

Section: Data Collection and Analysismentioning

confidence: 99%

“…The four-box or four quadrant approach takes a more practical and clinically oriented approach to ethical challenges. Within this framework, all ethical problems are analyzed in the context of four topics: medical indications, patient preferences, quality of life, and contextual features (that is social, economic, legal, and administrative) (18). Each topic can be approached through a set of speci c questions with the goal of identifying various circumstances of a given case and linking them to their underlying ethical principle.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Ethical challenges of the healthcare transition to adult Antiretroviral therapy (ART) clinics for HIV infected adolescents and young people in Uganda

Mbalinda¹,

Bakeera-Kitaka²,

Amooti³

et al. 2020

Preprint

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Introduction Many HIV infected adolescents require transfer of care from paediatric/ adolescent clinics to adult ART clinics. Transition is beset with factors that hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a successful transition. The purpose of this study was to analyse the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics. Method We conducted 18 focus group discussions among 191 adolescents attending 9 different health facilities in Uganda. We explored facilitators and barriers regarding adolescent transitioning to adult HIV clinics. Thematic data analysis was used to analyze the data. The Silences Framework guided the data analysis and interpretation. The principles of Bioethics and the four-boxes ethics framework for clinical care (Patient autonomy, Medical indications, Context of care and Quality of life) were used to analyze the ethical issues surrounding the transition to adult HIV care. Results The key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of both privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort; and contextual factors are critical to successful transition. Conclusion The priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition to ensure retention in HIV care, facilitate long-term self-care, provide ongoing holistic healthcare and support in order to promote health and wellbeing, and build trust in the healthcare system. Identifying what facilitates successful transitions, and the gaps that interventions can target, may ensure HIV-infected youth remain healthy across the healthcare transition.

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“…HIV prevalence is four times higher among young women compared to young men [5] increasing the risk for perinatal transmission. There is a growing number of adolescents and young adults with HIV who require the transfer of care from pediatric to adult providers; yet, globally, many young people experience barriers (e.g., infrastructure, staff training) that complicate this process [1,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…These studies do not reflect the challenges of HIV care in sub-Saharan Africa, given that limited-resources increases the complexity of transition and its evaluation. Asire and colleagues assessed both private and public clinics in Uganda caring for YPLHIV and found that only 3% of healthcare facilities had a specific health transition clinic (HTC) to support the transition from pediatric providers to adult providers [7]. Additionally, Nyabigambo and colleagues found that HTC use is less common in those who are older (age [20][21][22][23][24], male, live in rural locations, acquired HIV behaviorally, are not on antiretroviral therapy (ART), and have CD4 counts > 250 [9].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: unintended consequences of successful adolescent ART clinics

Mbalinda

Bakeera-Kitaka

Lusota

et al. 2020

BMC Health Serv Res

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Background: There is a growing number of adolescents and young adults living with HIV (YPLHIV) who require the transfer of care from pediatric/ adolescent clinics to adult Antiretroviral therapy (ART) clinics. A successful transition is critical for optimum health outcomes, yet facilities may lack infrastructure, human resources (with appropriate knowledge and skills), and a supportive environment, as only 3% of clinics in Uganda caring for YPLHIV have a process for supporting this critical transition from pediatric to adult care, and, facilitators and barriers of a successful transition are not well documented. The purpose of this study was to explore the facilitators and barriers of transitioning among adolescents from adolescent clinics to adult ART clinics. Method: Eighteen focus group discussions were held in nine health facilities with 174 adolescents and YPLHIV to assess barriers and facilitators regarding transitioning to adult clinics. The focus group discussions were audiorecorded and transcribed. The Silences Framework using a thematic approach guided the analysis. Results: The key emerging issues were: Unfriendly adults in adult clinics, Care provided in the adolescent clinics, fear of stigma from health care providers, Congestion and long waiting time, fear to lose friends were barriers to transitioning. Transitioning preparation is key to a successful transition, moving as a cohort facilitates transition, and care in adult clinics offers new opportunities, could facilitate readiness and transition.

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Adolescent HIV Care and Treatment in Uganda: Care Models, Best Practices and Innovations to Improve Services

Cited by 8 publications

References 12 publications

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: Unintended consequences of successful adolescent ART clinics

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: Unintended consequences of successful adolescent ART clinics

Ethical challenges of the healthcare transition to adult Antiretroviral therapy (ART) clinics for HIV infected adolescents and young people in Uganda

Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: unintended consequences of successful adolescent ART clinics

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