Background: Adolescents and young adults (AYA) have disproportionately worse clinical outcomes. We measured retention in HIV care, and evaluated correlates of retention, among AYA at 24 public HIV clinics enrolled in a stepped-wedge randomized trial of standardized patient actor training to improve quality of care and AYA clinical outcomes (SPEED Study).
Methods: Eligible records were from AYA ages 10-24 enrolled at 24 HIV clinics with ≥40 AYA active clients in Central (Nairobi, Kiambu counties) and Western (Kisumu, Homa Bay counties) Kenya during the 15 months preceding the trial (11/1/2015-3/31/2017). Sociodemographics, clinical characteristics, and visit dates were abstracted from electronic medical records (EMR). Facility-level surveys assessed any prior AYA-focused training and services. Surveys with individual health providers working in AYA HIV care (3-10 per facility) assessed self-reported history of AYA-specific trainings, experience caring for AYA, and self-rated competency; facility-level means were derived from individual responses. Retention in care was defined as return for first follow-up visit within 3 months among newly enrolled or recently re-engaged AYA. Multi-level regression modeling was used to estimate risk ratios (RRs) and 95% Confidence Intervals (CIs) between facility and individual cofactors and AYA retention. Final models adjusted for AYA age and clinic volume (total AYA enrolled during period).
Results: Among 3,656 AYA records at first eligible visit, most were female (75.0%), older (20-24 years: 54.3%), and on ART (79.5%). Overall, 2,636 AYA were retained (72.1%), with retention higher among females (73.1% vs. males 68.9%), older AYA (20-24 years: 75.0% vs. 10-14: 69.2%, 15-19: 68.0%), and at Western Kenya clinics (82.7% vs. 66.0% Central) (Table 1). Clinics where >20% health providers reported being trained in adolescent-friendly care had higher AYA retention than those with ≤20% of providers trained (85.4% vs. 66.4%, aRR 1.18, 95%CI:1.08-1.29). Clinics using the Kenyan government''s AYA package of care checklist had significantly higher overall AYA retention (88.9% vs. 69.2%;aRR 1.14, 95%CI:1.06-1.23).
Conclusions: Results suggest sub-optimal retention among HIV-positive AYA in Kenya. This is one of the first studies demonstrating that adolescent-specific health provider training and services may improve AYA retention, suggesting that health provider interventions are necessary to achieve the ''90-90''-90'' targets for AYA.

Table 1. Individual and Facility Cofactors of AYA Retention in HIV Care in Kenya (N=3,656 AYA)
[Table 1. Individual and Facility Cofactors of AYA Retention in HIV Care in Kenya (N=3,656 AYA)]

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