A Pilot Study of “Peer Navigators” to Promote Uptake of HIV Testing, Care and Treatment Among Street-Connected Children and Youth in Eldoret, Kenya

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Abstract

Research suggests a burden of HIV among street-connected youth (SCY) in Kenya. We piloted the use of peer navigators (PNs), individuals of mixed HIV serostatus and with direct experience of being street-connected, to link SCY to HIV testing and care. From January 2015 to October 2017, PNs engaged 781 SCY (585 male, 196 female), median age 16 (IQR 13–20). At initial encounter, 52 (6.6%) were known HIV-positive and 647 (88.8%) agreed to HIV testing. Overall, 63/781 (8.1%) SCY engaged in this program were HIV-positive; 4.6% males and 18.4% females (p < 0.001). Of those HIV-positive, 48 (82.8%) initiated ART. As of October 2017, 35 (60.3%) of the HIV-positive SCY were alive and in care. The pilot suggests that PNs were successful in promoting HIV testing, linkage to care and ART initiation. More research is needed to evaluate how to improve ART adherence, viral suppression and retention in care in this population.

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Responding to the HIV pandemic: the power of an academic medical partnership.

R Einterz, J Mamlin, Máire Quigley … (2007)

Partnerships between academic medical center (AMCs) in North America and the developing world are uniquely capable of fulfilling the tripartite needs of care, training, and research required to address health care crises in the developing world. Moreover, the institutional resources and credibility of AMCs can provide the foundation to build systems of care with long-term sustainability, even in resource-poor settings. The authors describe a partnership between Indiana University School of Medicine and Moi University and Moi Teaching and Referral Hospital in Kenya that demonstrates the power of an academic medical partnership in its response to the HIV/AIDS pandemic in sub-Saharan Africa. Through the Academic Model for the Prevention and Treatment of HIV/AIDS, the partnership currently treats over 40,000 HIV-positive patients at 19 urban and rural sites in western Kenya, now enrolls nearly 2,000 new HIV positive patients every month, feeds up to 30,000 people weekly, enables economic security, fosters HIV prevention, tests more than 25,000 pregnant women annually for HIV, engages communities, and is developing a robust electronic information system. The partnership evolved from a program of limited size and a focus on general internal medicine into one of the largest and most comprehensive HIV/AIDS-control systems in sub-Saharan Africa. The partnership's rapid increase in scale, combined with the comprehensive and long-term approach to the region's health care needs, provides a twinning model that can and should be replicated to address the shameful fact that millions are dying of preventable and treatable diseases in the developing world.

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HIV System Navigation: an emerging model to improve HIV care access.

Sharon Coleman, William A. Cunningham, B Bradford (2006)

Little is known about the effectiveness of outreach interventions to engage and retain underserved populations living with HIV in stable, primary medical care. This study provided an opportunity to adapt a patient navigation model first developed for cancer care to assess its effectiveness with HIV-infected disadvantaged populations. Four grantees from the Health Resources and Services Administration (HRSA)-funded Outreach Initiative developed and successfully implemented navigation-like interventions. We examined the effectiveness of these interventions in decreasing barriers to HIV primary medical care and improving health outcomes. The conceptual framework laid out in the 1993 Institute of Medicine report Access to Health Care in America provided a valuable heuristic for guiding the analysis, and we used the model to select measures for the study. A reduction in barriers, improvement in mediators, and improved health outcomes were observed over the 12-month intervention period. Structural barriers to HIV care and provider engagement were significantly associated with health outcomes. Based on study results, we propose that an adapted navigation approach referred to as "HIV System Navigation" has promise for improving access to HIV care and warrants further development.

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Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave

Brian C. Zanoni, Moherndran Archary, Sarah Buchan … (2016)

Context South Africa has the most HIV infections of any country in the world, yet little is known about the adolescent continuum of care from HIV diagnosis through viral suppression. Objective To determine the adolescent HIV continuum of care in South Africa. Data sources We searched PubMed, Google Scholar and online conference proceedings from International AIDS Society (IAS), International AIDS Conference (AIDS) and Conference on Retrovirology and Opportunistic Infections (CROI) from 1 January 2005 to 31 July 2015. Data extraction We selected published literature containing South African cohorts and epidemiological data reporting primary data for youth (15–24 years of age) at any stage of the HIV continuum of care (ie, diagnosis, treatment, retention, viral suppression). For the meta-analysis we used six sources for retention in care and nine for viral suppression. Results Among the estimated 867 283 HIV-infected youth from 15 to 24 years old in South Africa in 2013, 14% accessed antiretroviral therapy (ART). Of those on therapy, ∼83% were retained in care and 81% were virally suppressed. Overall, we estimate that 10% of HIV-infected youth in South Africa in 2013 were virally suppressed. Limitations This analysis relies on published data from large mostly urban South Africa cohorts limiting the generalisability to all adolescents. Conclusions Despite a large increase in ART programmes in South Africa that have relatively high retention rates and viral suppression rates among HIV-infected youth, only a small percentage are virally suppressed, largely due to low numbers of adolescents and young adults accessing ART.

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Author and article information

Contributors

Paula Braitstein:

ORCID: http://orcid.org/0000-0003-0541-2955

+ 254 728 825 620 , pbraitstein@gmail.com

Journal

Journal ID (nlm-ta): AIDS Behav

Journal ID (iso-abbrev): AIDS Behav

Title: AIDS and Behavior

Publisher: Springer US (New York )

ISSN (Print): 1090-7165

ISSN (Electronic): 1573-3254

Publication date (Electronic): 29 September 2018

Publication date PMC-release: 29 September 2018

Publication date (Print): 2019

Volume: 23

Issue: 4

Pages: 908-919

Affiliations

[1 ]Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

[2 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Epidemiology, Dalla Lana School of Public Health, , University of Toronto, ; 155 College Street, 5th Floor, Toronto, ON M5T 3M7 Canada

[3 ]ISNI 0000 0001 0495 4256, GRID grid.79730.3a, Department of Behavioral Sciences, School of Medicine, College of Health Sciences, , Moi University, ; Eldoret, Kenya

[4 ]Moi Teaching and Referral Hospital, Eldoret, Kenya

[5 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Faculty of Medicine, Institute of Medical Science, , University of Toronto, ; Toronto, Canada

[6 ]ISNI 0000 0001 2287 3919, GRID grid.257413.6, Department of Pediatrics, School of Medicine, , Indiana University, ; Indianapolis, USA

[7 ]ISNI 0000 0001 0495 4256, GRID grid.79730.3a, Department of Medicine, School of Medicine, College of Health Sciences, , Moi University, ; Eldoret, Kenya

Author information

Paula Braitstein http://orcid.org/0000-0003-0541-2955

Article

Publisher ID: 2276

DOI: 10.1007/s10461-018-2276-1

PMC ID: 6458975

PubMed ID: 30269232

SO-VID: 4214a360-3f92-4b64-9361-086caf3e812a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.