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Health provider training is associated with improved engagement in HIV care among adolescents and young adults in Kenya.

  • Wilson, Kate S1
  • Mugo, Cyrus1, 2
  • Moraa, Hellen3
  • Onyango, Alvin3
  • Nduati, Margaret3
  • Inwani, Irene3
  • Bukusi, David4
  • Slyker, Jennifer1, 5
  • Guthrie, Brandon L1, 5
  • Richardson, Barbra A1, 6
  • John-Stewart, Grace C1, 5, 7, 8
  • Wamalwa, Dalton3
  • Kohler, Pamela K1, 9
  • 1 Department of Global Health, University of Washington, Seattle, Washington, USA.
  • 2 Department of Research and Programs, Kenyatta National Hospital. , (Kenya)
  • 3 Department of Pediatrics and Child Health, University of Nairobi.
  • 4 Voluntary Counseling and Tescting and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya. , (Kenya)
  • 5 Department of Epidemiology.
  • 6 Department of Biostatistics.
  • 7 Department of Pediatrics.
  • 8 Department of Medicine.
  • 9 Division of Psychosocial and Community Health, University of Washington, Seattle, Washington, USA.
Published Article
AIDS (London, England)
Publication Date
Jul 15, 2019
DOI: 10.1097/QAD.0000000000002217
PMID: 30932957


Adolescents and young adults (AYA) have poorer retention, viral suppression, and survival than other age groups. We evaluated correlates of initial AYA engagement in HIV care at facilities participating in a randomized trial in Kenya. Retrospective cohort study. Electronic medical records from AYA ages 10-24 attending 24 HIV care facilities in Kenya were abstracted. Facility surveys assessed provider trainings and services. HIV provider surveys assessed AYA training and work experience. Engagement in care was defined as return for first follow-up visit within 3 months among newly enrolled or recently re-engaged (returning after >3 months out of care) AYA. Multilevel regression estimated risk ratios and 95% confidence intervals (CIs), accounting for clustering by facility. Final models adjusted for AYA individual age and median AYA age and number enrolled per facility. Among 3662 AYA records at first eligible visit, most were female (75.1%), older (20-24 years: 54.5%), and on antiretroviral therapy (79.5%). Overall, 2639 AYA returned for care (72.1%) after enrollment or re-engagement visit. Engagement in care among AYA was significantly higher at facilities offering provider training in adolescent-friendly care (85.5 vs. 67.7%; adjusted risk ratio (aRR) 1.11, 95% CI: 1.01-1.22) and that used the Kenyan government's AYA care checklist (88.9 vs. 69.2%; aRR 1.14, 95% CI: 1.06-1.23). Engagement was also significantly higher at facilities where providers reported being trained in AYA HIV care (aRR 1.56, 95% CI: 1.13-2.16). Adolescent-specific health provider training and tools may improve quality of care and subsequent AYA engagement. Health provider interventions are needed to achieve the '95-95-95' targets for AYA.

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