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Title
Adolescent-specific provider training and provision of services is associated with retention in Kenyan HIV clinics
Presenter
Kate Wilson
Authors
K. Wilson1, C. Mugo2, H. Moraa3, A. Onyango3, M. Nduati3, I. Inwani4, J. Slyker1,5, B. Guthrie1,5, B. Richardson1,6, G. John-Stewart1,5,7, D. Bukusi8, D. Wamalwa9, P. Kohler1,10
Institutions
1University of Washington, Global Health, Seattle, United States, 2University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya, 3University of Nairobi, Nairobi, Kenya, 4Kenyatta National Hospital, Nairobi, Kenya, 5University of Washington, Department of Epidemiology, Seattle, United States, 6University of Washington, Department of Biostatistics, Seattle, United States, 7University of Washington, Department of Medicine, Seattle, United States, 8Kenyatta National Hospital, VCT and HIV Prevention Unit/Youth Centre, Nairobi, United States, 9University of Nairobi, Department of Pediatrics and Child Health, Nairobi, Kenya, 10University of Washington, School of Nursing/Department of Psychology and Community Health, Seattle, United States

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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