Training Years: 2013-2014
Training Site: Infectious Disease Institute, Makerere University
Mentor: Allison Agwu, MD; Yuka Manabe, MD
Title: Comprehensive Youth-Friendly HIV Care for Adolescents and Young Adults in Kampala, Uganda: A Model of Care
Aim 1: To compare the clinical outcomes (immunologic stability/CD4 increase, presumed virologic suppression, no new AIDS-related comorbidities), adherence to scheduled visits and ART (if taking), utilization of services (sexual and reproductive health, peer support groups), and retention in care (follow-up ≥1 year following entry into care) for YLHIV ages 16-24 in care at a youth-only transition clinic compared to YLHIV ages 16-24 and adults (≥25 years) in the general adult clinic in Kampala, Uganda.
Hypothesis 1a: Compared to adults in the general adult clinic, YLHIV in care at the same adult clinic will have less favorable clinical outcomes, adherence rates, clinical service utilization, and retention in care.
Hypothesis 1b: Among all YLHIV, those in care at the youth-only transition clinic will have higher rates of favorable clinical outcomes, adherence rates, utilization of clinical services, and retention in care compared to those at the general adult clinic.
Aim 2: To quantitatively characterize the clinical and psychosocial features of YLHIV and clinic-level features considered youth-friendly which are associated with favorable clinical outcomes, adherence to scheduled visits and ART (if taking), utilization of services, and retention in care for YLHIV ages 16-24 attending a youth-only transition clinic compared to YLHIV ages 16-24 attending a general adult clinic in Kampala, Uganda. Hypothesis 2a: YLHIV attending a youth-only transition clinic will be intrinsically different than YLHIV attending the adult clinic. Specifically, these YLHIV are more likely to be younger at age of diagnosis, perinatally-infected, on ART, and have a preference for peer connectedness compared to YLHIV attending a general adult clinic.
Hypothesis 2b: At the clinic level, availability of youth peer support groups, youth-oriented providers, and comprehensive youth-oriented health services will be associated with favorable outcomes.
Aim 3: To qualitatively explore YLHIV preferences and expectations regarding youth-friendly clinicfeatures that may assist with adherence and retention in care, and youth satisfaction and acceptability of available services at both youth-only and general adult clinic sites.
Question 3a: What are the facilitators and barriers to care for YLHIV at their respective clinical sites, and how do YLHIV determine where to receive care?
Question 3b: What provider (e.g. attitudes towards youth, teaching style) and clinic features (e.g. environment, efficiency, hours of operation, programs), do YLHIV find useful in assisting with adherence and retention in care and what are other areas YLHIV seek assistance to prepare them for adult management of health?
NIH Support: Fogarty fellowship postdoctoral training award