Life Skills Improve Psychosocial and Clinical Outcomes Among Adolescents Living with HIV Transitioning to Adult Care

Abstract

Purpose HIV- related deaths account for the highest mortality among adolescents and young people in Africa. Studies evaluating the most effective interventions to support disclosure in sub-Saharan Africa have not focused on programs providing life skills aimed at empowering adolescents living with HIV (ALWHIV) to navigate the health system. The overall objective of this study was to evaluate the effect of introducing a life skills curriculum as a transition to adult care support tool among perinatally infected adolescents in Nairobi, Kenya. Methods This study employed a randomized clinical trial design and utilized a mix-methods approach. We enrolled 58 adolescents for the qualitative research component and conducted 8 FGDS and 10 IDI. We pilot tested the curriculum among an additional 82 (ALWHIV) adolescents randomized to an intervention arm (n=42) (receiving the life skills utilizing the modified curriculum and standard care) and a control arm (n=40) Based on the qualitative data, an existing life-skills curriculum from Baylor’s school of medicine was adapted curriculum and contextualized to include identified additional topics. Viral suppression was the primary outcome while self-efficacy and and self-esteem. were secondary outcomes. Thematic analysis was conducted for the analysis of qualitative data. Regression analysis was conducted to identify determinants of adherence and difference in difference analysis to analyse outcomes between the two study arms.id not emerge as relevant. We pilot tested the curriculum among an additional 82 (ALWHIV) adolescents randomized to an intervention arm (n=42) Results Five major themes were identified during the exploration of the psychosocial needs: the presence of unmet post-disclosure psychosocial needs, trauma and stigma-related psychosocial support needs, a gap in HIV treatment and prevention information & the desire by adolescents to receive guidance on how to achieve their goals and aspirations. ART Adherence self-efficacy was associated with an eight times more likelihood of self-reported adherence ≥95% [OR 8.1, 95% CI (2.31- 28.18)]. Once a day, dosing was also independently associated with adherence [O.R 3.8, 95% CI (1.11-12.72)]. The self-reported adherence ≥95% measure utilized had a high correlation with viral loads of <1000 copies ml (Kappa= 0.87). ART adherence self-efficacy was significantly higher among the adolescents in the intervention group (p=0.012). Viral suppression was also significantly higher than in the intervention group (p=0.003). There was a significant difference in self-esteem between the two arms (p=0.04). Conclusions here is a need to strengthen the implementation of timely disclosure and revision of psychosocial care training content used by health workers to meet the needs of older adolescents. Sources of Support Support for data collection for this project was provided by the Fogarty International Centre of the National Institutes of Health (NIH) under Award Number D43TW009343 and the University of California Global Health Institute (UCGHI) to NGK. The content is solely the responsibility of the authors and does not represent the official views of the NIH or UCGHI. All the authors declare that they have no conflicts of interest. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.