Determinants of Feasibility, Acceptability, and Fidelity of an Adolescent Transition Package (ATP) for Adolescents living with HIV in Kenya

Abstract

University of Washington AbstractDeterminants of Feasibility, Acceptability, and Fidelity of an Adolescent Transition Package (ATP) for Adolescents living with HIV in Kenya Chelsea Martin Chair of the Supervisory Committee:Bryan Weiner Department of Health Systems and Population Health Background: Adolescents living with HIV (ALH) experience the largest health disparities among individuals with HIV due to the lack of transition services to adult care. The Adolescent Transition to Adult Care for Adolescents Living with HIV (ATTACH) study was created to test the Adolescent Transition Package (ATP) intervention on its effectiveness. Methods: Researchers from ATTACH and the UW conducted an RCT among 20 Kenyan implementation sites, 10 of which had in-depth interviews and focus group discussions using CFIR constructs to understand the determinants of acceptability, feasibility, and fidelity in implementing ATP. A thematic qualitative analysis of health care workers’ responses was conducted to understand perceptions of readiness outcomes among adolescents. Results: Providers were overall satisfied with the impact they observed in adolescent readiness and clinical outcomes. Implementation was influenced by the compatibility of the implementation sites for organizational support and their setting’s need for the use of ATP tools. The design quality of ATP and its initial training enabled HCWs to feel confident during delivery and provided helpful pictures for adolescent understanding, even while navigating complications from translation inconsistencies. HCWs agreed more individuals should be trained on ATP use to increase fidelity in implementation and increase the organizational manpower. Discussion: Other studies have shown the need for scalable health systems-strengthening interventions to improve transition services for young adults. The successful determinants of implementation for ATP in the contexts of this study can motivate providers of other similar clinics to gain ATP training to address gaps in transition service practice. However, further research is necessary in this field to understand young adult health outcomes immediately following transition services from the ATP intervention.