Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: unintended consequences of successful adolescent ART clinics
Loading...
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Background: There is a growing number of adolescents and young adults living with HIV (YPLHIV) who require the
transfer of care from pediatric/ adolescent clinics to adult Antiretroviral therapy (ART) clinics. A successful transition
is critical for optimum health outcomes, yet facilities may lack infrastructure, human resources (with appropriate
knowledge and skills), and a supportive environment, as only 3% of clinics in Uganda caring for YPLHIV have a
process for supporting this critical transition from pediatric to adult care, and, facilitators and barriers of a successful
transition are not well documented. The purpose of this study was to explore the facilitators and barriers of
transitioning among adolescents from adolescent clinics to adult ART clinics.
Method: Eighteen focus group discussions were held in nine health facilities with 174 adolescents and YPLHIV to
assess barriers and facilitators regarding transitioning to adult clinics. The focus group discussions were audiorecorded
and transcribed. The Silences Framework using a thematic approach guided the analysis.
Results: The key emerging issues were: Unfriendly adults in adult clinics, Care provided in the adolescent clinics,
fear of stigma from health care providers, Congestion and long waiting time, fear to lose friends were barriers to
transitioning. Transitioning preparation is key to a successful transition, moving as a cohort facilitates transition, and
care in adult clinics offers new opportunities, could facilitate readiness and transition Conclusion: YPLHIV expressed fear to transition to adult clinics mainly because of the perceived better care provided
in the adolescent clinic, thus constituting a barrier to smooth transition A range of individual, social and health system
and services-related factors hindered transitioning. The expectation of transitioning as a group, assurance of similar care
as in the adolescent clinic, and guarantees of confidentiality, privacy, and autonomy in decision-making for care was
perceived as facilitators. Understanding barriers and facilitators can enable the Ministry of Health to improve the quality
of life of YPLHIV through linkage to care, adherence, retention, and viral suppression. There is a need to better planning
and preparation for clinical providers and YPLHIV with a focus on age-appropriate and individualized case
management transition as well as focus on improving both clinical and psychosocial support throughout the process.
Description
Keywords
HIV, Adolescents, Transitioning, Facilitators, Barriers, ART clinics
Citation
Mbalinda, S. N., Bakeera-Kitaka, S., Lusota, D. A., Magongo, E. N., Musoke, P., & Kaye, D. K. (2020). Barriers and facilitators for transitioning of young people from adolescent clinics to adult ART clinics in Uganda: unintended consequences of successful adolescent ART clinics. BMC Health Services Research, 20(1), 1-12.https://doi.org/10.1186/s12913-020-05701-9