Patient and Provider Perceptions of a Community-Based Accompaniment Intervention for Adolescents Transitioning to Adult HIV Care in Urban Peru: A Qualitative Analysis

Abstract

Introduction: Adolescents living with HIV (ALWH) experience higher mortality rates compared to other age groups, exacerbated by suboptimal transition from pediatric to adult HIV care in which decreased adherence to antiretroviral treatment (ART) and unsuppressed viremia are frequent. Care transition—a process lasting months or years—ideally prepares ALWH for adult care and can be improved by interventions that are youth–friendly and address psychosocial issues affecting ART adherence; however, such interventions are infrequently operationalized. Community–based accompaniment (CBA), in which laypeople provide individualized support and health system navigation, can improve health outcomes among adults with HIV. Here, we describe patient and provider perceptions of a novel HIV CBA intervention called PASEO for ALWH in Lima, Peru. Methods: PASEO consisted of six core elements designed to support ALWH before, during, and after transition to adult HIV care. Community-based health workers provided tailored accompaniment for ALWH aged 15–21 years over 9 months, after which adolescent participants were invited to provide feedback in a focus group or in–depth interview. HIV care personnel were also interviewed to understand their perspectives on PASEO. A semi–structured interview guide probing known acceptability constructs was used. Qualitative data were analyzed using a Framework Analysis approach and emergent themes were summarized with illustrative quotes. Results: We conducted 5 focus groups and 11 in–depth interviews among N=26 ALWH and 9 key–informant interviews with HIV care personnel. ALWH participants included males, females, and one transgender female, and those with both vertically– and behaviorally acquired HIV. ALWH praised PASEO, attributing increased ART adherence to the project. Improved mental health, independence, self–acceptance, and knowledge on how to manage their HIV were frequently cited. HIV professionals similarly voiced strong support of PASEO. Both ALWH and HIV professionals expressed hope that PASEO would be scaled. HIV professionals voiced concerns regarding financing PASEO in the future. Conclusion: A multicomponent CBA intervention to increase ART adherence among ALWH in Peru was highly acceptable by ALWH and HIV program personnel. Future research should determine the efficacy and economic impact of the intervention.