Policy-makers’ perspectives on optimizing HIV-infected adolescents’ transition from pediatric to adult care in Kenya

Abstract

Background: The transition from pediatric to adult care has emerged as a potential contributor to poor clinical outcomes and challenges to retention in care among adolescents living with HIV (ALHIV). While structured processes and tools that bridge the gap between pediatric and adult care can help ensure HIV-infected adolescents and young adults are retained in care and supported through this developmental transition, additional context-specific data are needed to improve the transition process. This study elicited perspectives of policy-makers regarding barriers and facilitators to successful transition outcomes among ALHIV in Kenya. Methods: We conducted 20 individual in-depth interviews (IDIs) with a diverse group of policy-makers in Kenya. IDIs were conducted using a semi-structured guide, designed to elicit policy-maker perspectives on current policies, tools and practices for transitioning adolescents from pediatric to adult care. IDIs were conducted in English, audio-recorded and transcribed verbatim. Transcripts were coded using ATLAS.ti, and the socio-ecological model was used to characterize themes related to multilevel optimization of the transition process for ALHIV. Results: Policy-makers identified multilevel and interrelated factors impacting HIV-infected adolescents’ transition from pediatric to adult care. At the interpersonal level, the influence of adolescents’ primary caregivers was paramount and contributed to adherence and retention in care throughout the transition trajectory. At the institutional level, key themes related to successful transition included the need for gradual, structured, and inclusive preparation of adolescents, and the pivotal role of healthcare workers (HCWs) in the development of a comprehensive care relationship between HCWs, caregivers and adolescents. Key themes at the structural level were the need for expanded transition guidelines and improved HCW training. Conclusions: There is an urgent need for expanded transition tools and guidelines focused on strategies to improve caregiver involvement, engage adolescents in illness management, and provide commensurate support and guidance for HCWs. As relatively little research on adolescents’ transition from pediatric to adult care has been conducted in SSA, additional context-specific studies are needed to fill this gap and inform regional policy development.