Self-Rated Competence among HIV Care Providers Working with Adolescents in Kenya

Abstract

University of Washington Abstract Self-Rated Competence among HIV Care Providers Working with Adolescents in Kenya Elizabeth Ann Karman Chair of the Supervisory Committee: Dr. Pamela Kohler Department of Global Health Department of Psychosocial and Community Health Introduction: Adolescents living with HIV in Sub-Saharan Africa have disproportionately poor linkage to and retention in HIV care compared to other age groups. Health Care Workers (HCWs) serving adolescents living with HIV in Kenya have reported that they feel ill-prepared to work effectively with this population. More understanding of the competence and skills of HCWs in caring for HIV-positive adolescents in Kenya is needed to understand the current state of HIV services, and to inform and target future HCW training interventions. Methods: Data were collected from managers of 24 health facilities providing HIV care to adolescents, as well as 142 HCWs working within the enrolled facilities, in four counties in Kenya. Participant HCWs completed a survey to assess their socio-demographic characteristics, training history, and self-rated competency in caring for HIV positive adolescents. Competence was measured by eight statements with Likert scale responses; space for optional text comments was available. Descriptive statistics were computed, and linear regression was used to identify correlates of HCW self-rated competency. Results: Few facilities offered ‘youth friendly’ space, services, or providers. Among HCWs, fewer than half, (n=57, 40.1%) reported receiving special training in youth friendly health services (YFHS) or the care of HIV positive adolescents. HCWs reported a median composite self-rated competency score of 78.1 on a scale of 1-100 (IQR: 68.8- 84.4), and most rated their competence highest in non-technical aspects of care. Variables significantly associated with higher self-rated competency included years of experience caring for HIV-positive individuals, past training in adolescent HIV care, and caring for 11-15 adolescents per week compared to lower or higher caseloads in univariate analyses. Years of experience in caring for HIV-positive adolescents and history of training in adolescent HIV care remained statistically significant after adjusting for confounding. Conclusion: Most surveyed HCWs had not received training in the care of adolescents living with HIV, and most facilities offering services to adolescents living with HIV did not offer YFHS. Though HCWs reported moderately high self-rated competence in providing services to this population, many also requested more training. This analysis suggests that training in the care of HIV-positive adolescents may have the most potential to increase self-rated competence when directed at HCWs with fewer years of experience, and/or no prior history of similar training.