Community-based accompaniment for adolescents transitioning to adult HIV care in urban Peru: a pilot study

Abstract

We piloted a community-based intervention to improve outcomes among adolescents living with HIV who were transitioning to adult-oriented care in Lima, Peru. We assessed feasibility and potential effectiveness, including within-person changes in self-reported adherence, psychosocial metrics (NIH Toolbox), and transition readiness (“Am I on TRAC” questionnaire, “Got Transition” checklist). From October 2019 to January 2020, we enrolled 30 adolescents (15–21 years). The nine-month intervention consisted of logistical, adherence and social support delivered by entry-level health workers and group sessions to improve health-related knowledge and skills and social support. In transition readiness, we observed within-person improvements relative to baseline. We also observed strong evidence of improvements in adherence, social support, self-efficacy, and stress, which were generally sustained three months post-intervention. All participants remained in treatment after 12 months. The intervention was feasible and potentially effective for bridging the transition to adult HIV care. A large-scale evaluation, including biological endpoints, is warranted.

Patient and provider perceptions of a community‐based accompaniment intervention for adolescents transitioning to adult HIV care in urban Peru: a qualitative analysis

“…We attempted to recruit a diverse group of adolescents, but only one transgender female participated; future studies must increase SGM participation. Further, we were unable to discuss ALWH's perceptions on viral load changes during PASEO because COVID‐19 disrupted viral load testing in Peru, and only baseline results were available [ 35 ]. Finally, the near uniformly positive responses from ALWH could be due to social desirability bias; however, this was minimized by collecting data after the intervention ended at the final study contact.…”

“…Likewise, HIV personnel praised PASEO, citing favourable experiences heard from adolescents. PASEO aimed to improve unsuppressed viremia among ALWH [35]; accordingly, the intervention focused on resolving ART adherence barriers. However, when ALWH spoke about PASEO, responses consistently centred on how each core element made them feel rather than the activity itself.…”

“…The PASEO intervention and feasibility results are detailed elsewhere [ 35 ]. Briefly, PASEO consisted of six core components (Figure 1 ) delivered over 9 months (a 6‐month intensive phase followed by a 3‐month step‐down phase) by paid entry‐level or lay‐health workers: 1.…”

“…Thirty ALWH naïve to SES participated, comprising those with early childhood or recently acquired HIV, cisgender males and females, males identifying as homosexual and a transgender female. When the SARS‐CoV‐2 (COVID‐19) pandemic required mandatory stay‐at‐home orders (March 2020), participants had received between 1.4 and 5.3 months of the intervention, after which we implemented virtual delivery of the intervention (detailed in [ 35 , 36 ]). Essentially, all previously in‐person study activities were conducted via telephone/videoconferencing (participants were provided data credits).…”

Development and Pilot-Testing of an Optimized Conversational Agent or “Chatbot” for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study

“…In Lima, Peru, we found evidence that depression care for adolescents living with HIV is an unmet health need unless symptoms are severe (eg, depression with psychosis and suicidal ideation) [ 23 ]. At the same time, we also observed in a small pilot study that the majority (92%) of adolescents living with HIV with depression did not have severe symptoms [ 24 ].…”