Sarah Shaw, MPH, PhD

Nominated From: University of Washington

Research Site: University of Nairobi

Research Area: Implementation Science and Adolescent HIV Care

Primary Mentor: Dr. Kristin Beima-Sofie and Dr. Irene Njuguna

Research Project

Identification of strategies for sustainability and scale up of an evidence-based adolescent transition package to improve HIV outcomes among youth living with HIV in Kenya

An estimated 3.4 million youth are living with HIV (YLHIV), the majority (78%) in sub-Saharan Africa (SSA). Compared to other age groups, YLHIV experience poor treatment outcomes including higher mortality, and lower viral suppression, ART adherence and retention in care. Knowledge and understanding of one’s HIV status, as well as transitioning toward independent HIV care management, are crucial for improving long term treatment outcomes among this population, yet few tools tailored for low- and middle-income settings have been developed and/or programmatically implemented at scale. To address this gap, the Adolescent Transition to Adult Care for HIV-infected Adolescents in Kenya (ATTACH) study evaluated transition practices and outcomes across clinics, collaboratively developed an Adolescent Transition Package (ATP) to systematically guide HCWs through the transition process, and implemented the ATP in a cluster randomized clinical trial in 20 clinics in Kenya. This current project builds off the ATTACH study to support the scale-up and sustainability of this tool. Understanding the barriers and facilitators impacting sustainability of the ATP and identifying core strategies to advance policy adoption and national scale-up will be critical to facilitate and strengthen the transition of the ATP from research to practice. This will be accomplished through the following three activities: 1. Conduct a qualitative comparative analysis to identify effective and necessary conditions to facilitate long-term and expanded implementation of the ATP in HIV settings in Kenya. 2. Pilot the delivery of the transition readiness assessment by health care workers (HCWs) in clinic settings, assessing implementation outcomes and HCWs’ readiness for implementing change. 3. Organize a user-centered design workshop with key stakeholders to develop a strategic plan for scaling up the ATP.

Research Significance

This study directly addresses the know-do gap between intervention effectiveness and scale-up/sustainability of evidence-based interventions. Additionally, this research will inform national level efforts to improve HIV treatment outcomes among youth living with HIV, thereby reducing mortality and enhancing quality of life among this population.


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