An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE-AIM Framework
Jerome Galagade 1, Victor Mwapasa 2
1,2School of Public Health, University of Malawi- College of Medicine, Blantyre, Malawi
*Corresponding Author: Jerome Galagade, College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre, Malawi. Email: email@example.com
Received date: 04 November, 2021 Accepted date: 23November, 2021 Published Date: 29 November, 2021
Citation: Galagade J (2021) An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE?AIM Framework. Sci J Health Sci Res Vol: 1, Issu: 1 (28-38).
Background: High attrition is a major problem for Adolescent Living with HIV (ALHIV) transitioning from pediatric to adult care. Although the HIV Teen Club model has been shown to promote antiretroviral (ARV) adherence and viral suppression among ALHIV, its effect on promoting transitioning ALHIV from pediatric to adult care has not been formally evaluated. We sought to estimate the proportion of ALHIV enrolled in HIV Teen Clubs who successfully transitioned to adult care within six months of the expected transition time and assess health facilities’ fidelity in implementing HIV Teen Clubs’ adult care transition protocols and factors associated with successful transition to adult Care.
Methods: Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance( RE-AIM) Framework, from September 2018 to June 2019, we conducted a quantitative retrospective descriptive cohort study and qualitative grounded theory study involving ALHIV attending HIV Teen Clubs in 14 primary health facilities in Blantyre, Malawi who had reached the recommended transition age of 18/19 years between July - December 2017. After obtaining consent, we reviewed their records to assess the proportion who successfully transitioned and also factors associated with transitioning. A checklist was used to ascertain fidelity of implementation of HIV Teen Club transition protocols. Key Informant Interviews were conducted with service providers (SP) in health facilities providing HIV Teen Club to get their perspectives on reasons for successful or unsuccessful transition.
Results: Of the 131 eligible ALHIV enrolled in the study, only 9 successfully transitioned to adult care within six months of the expected transition time representing effectiveness of 6.9%. The fidelity in implementing adult care transition protocols in most (n=10) health facilities was medium (A composite adherence score was categorized as low fidelity (score of less than 50), medium fidelity (a score of 50 but <70) and high fidelity (a score of 70 and above) based on the values of each of the elements). There was an association between implementation fidelity and ALHIV successful transition with 2 out of 3 health facilities with high implementation fidelity also successfully transitioning ALHIV into adult care. Successful ALHIV transitioning was associated with urban location of health facilities and ownership of the facilities by Non-Governmental Organization (NGOs). SPs reported that lack of training in transitioning ALHIV, lack of clear guidelines, inadequate human resource and refusal of ALHIV to transition were some of the health system factors negatively influencing successful transition.
Conclusion: Our findings raise concerns about the success of ALHIV transitioning in care against the backdrop of efforts of ensuring that ALHIV are retained in care. The lack of training and mentorship of SP in implementing transitioning protocols impede the capacity of these SP to assist ALHIV in effectively managing transitions.
Keywords: Adolescent, HIV, AIDS, Adhérence, transition in care, Teen Club, challenges.