Training Years: 2018-2019
Training Site: University of the Witwatersrand (Wits)
Country: South Africa
Mentors: Audrey Pettifor, PhD; Kathleen Kahn, PhD
Title: Multilevel factors influencing linkage to care among HIV positive adolescents in rural Mpumalanga province, South Africa
AIM 1: To characterize the HIV continuum of care among HIV positive young people aged 13-24 in Mpumalanga.
Approach: We will establish a cohort from an existing population-based clinic-linked dataset (Clinic Link) which includes electronic medical records (EMR) and longitudinal census data from the South African Medical and Research Council and Wits University’s Agincourt Health and Socio-Demographic Surveillance System (HDSS) to estimate the proportion of HIV positive young people linked to care within 90 days of diagnosis, started on ART, and virally suppressed 6, 12, and 24 months after HIV care initiation.
AIM 2: To assess the effects of individual, community, and structural level factors in three key areas— mental health and social support, substance use and abuse, and healthcare accessibility—on linkage to care among HIV positive young people in Mpumalanga.
2a. To assess the effect of mental health and social support (e.g. mental health illness, support after disclosure, utilization of community-based support groups) factors on linkage to care.
2b. To assess the effect of substance use and abuse on linkage to care.
2c. To assess the effect of healthcare accessibility (e.g. hours of operation, distance to nearest clinic, adolescent friendly services) on linkage to care.
Approach: We will sample 700 HIV positive young people aged 13-24, 350 of whom attended a medical appointment for CD4 count measurement within 90 days of HIV diagnosis, and 350 of whom did not, from the Clinic Link dataset and interview them to identify individual level factors associated with linkage to care. We will triangulate these results with existing EMR, census data, and area clinic assessments to subsequently identify community and structural level factors also associated with this outcome.
AIM 3: To quantify the potential effect of intervening on various factors associated with poor linkage to HIV care, on the proportion of HIV positive young people linked to care within 90 days of HIV diagnosis.
Approach: We will model the potential effects of hypothetical intervention programs that target the factors found to be associated with low levels of linkage to care in AIM 2. We will assess possible interaction among interventions targeting multi-level factors in an effort to identify the most effective intervention programs.
NIH Support: Fogarty scholars doctoral training award