“At our age, we would like to do things the way we want: ” a qualitative study of adolescent HIV testing services in Kenya

OBJECTIVES:Adolescents in Africa have low HIV testing rates. Better understanding of adolescent, provider, and caregiver experiences in high-burden countries such as Kenya could improve adolescent HIV testing programs. DESIGN:We conducted 16 qualitative interviews with HIV-positive and HIV-negative...

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Veröffentlicht in:AIDS (London) 2017-07, Vol.31 Suppl 3 (Supplement 3), p.S213-S220
Hauptverfasser: Wilson, Kate S, Beima-Sofie, Kristin M, Moraa, Helen, Wagner, Anjuli D, Mugo, Cyrus, Mutiti, Peter M, Wamalwa, Dalton, Bukusi, David, John-Stewart, Grace C, Slyker, Jennifer A, Kohler, Pamela K, O’Malley, Gabrielle
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container_end_page S220
container_issue Supplement 3
container_start_page S213
container_title AIDS (London)
container_volume 31 Suppl 3
creator Wilson, Kate S
Beima-Sofie, Kristin M
Moraa, Helen
Wagner, Anjuli D
Mugo, Cyrus
Mutiti, Peter M
Wamalwa, Dalton
Bukusi, David
John-Stewart, Grace C
Slyker, Jennifer A
Kohler, Pamela K
O’Malley, Gabrielle
description OBJECTIVES:Adolescents in Africa have low HIV testing rates. Better understanding of adolescent, provider, and caregiver experiences in high-burden countries such as Kenya could improve adolescent HIV testing programs. DESIGN:We conducted 16 qualitative interviews with HIV-positive and HIV-negative adolescents (13–18 years) and six focus group discussions with Healthcare workers (HCWs) and caregivers of adolescents in Nairobi, Kenya. METHODS:Semi-structured interviews and focus groups were recorded and transcribed. Analysis employed a modified constant comparative approach to triangulate findings and identify themes influencing testing experiences and practices. RESULTS:All groups identified that supportive interactions during testing were essential to the adolescentʼs positive testing experience. HCWs were a primary source of support during testing. HCWs who acted respectful and informed helped adolescents accept results, link to care, or return for repeat testing, whereas HCWs who acted dismissive or judgmental discouraged adolescent testing. Caregivers universally supported adolescent testing, including testing with the adolescent to demonstrate support. Caregivers relied on HCWs to inform and encourage adolescents. Although peers played less significant roles during testing, all groups agreed that school-based outreach could increase peer demand and counteract stigma. All groups recognized tensions around adolescent autonomy in the absence of clear consent guidelines. Adolescents valued support people during testing but wanted autonomy over testing and disclosure decisions. HCWs felt pressured to defer consent to caregivers. Caregivers wanted to know results regardless of adolescents’ wishes. CONCLUSION:Findings indicate that strengthening HCW, caregiver, and peer capacities to support adolescents while respecting their autonomy may facilitate attaining ‘90-90-90’ targets for adolescents.
doi_str_mv 10.1097/QAD.0000000000001513
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Better understanding of adolescent, provider, and caregiver experiences in high-burden countries such as Kenya could improve adolescent HIV testing programs. DESIGN:We conducted 16 qualitative interviews with HIV-positive and HIV-negative adolescents (13–18 years) and six focus group discussions with Healthcare workers (HCWs) and caregivers of adolescents in Nairobi, Kenya. METHODS:Semi-structured interviews and focus groups were recorded and transcribed. Analysis employed a modified constant comparative approach to triangulate findings and identify themes influencing testing experiences and practices. RESULTS:All groups identified that supportive interactions during testing were essential to the adolescentʼs positive testing experience. HCWs were a primary source of support during testing. HCWs who acted respectful and informed helped adolescents accept results, link to care, or return for repeat testing, whereas HCWs who acted dismissive or judgmental discouraged adolescent testing. Caregivers universally supported adolescent testing, including testing with the adolescent to demonstrate support. Caregivers relied on HCWs to inform and encourage adolescents. Although peers played less significant roles during testing, all groups agreed that school-based outreach could increase peer demand and counteract stigma. All groups recognized tensions around adolescent autonomy in the absence of clear consent guidelines. Adolescents valued support people during testing but wanted autonomy over testing and disclosure decisions. HCWs felt pressured to defer consent to caregivers. Caregivers wanted to know results regardless of adolescents’ wishes. CONCLUSION:Findings indicate that strengthening HCW, caregiver, and peer capacities to support adolescents while respecting their autonomy may facilitate attaining ‘90-90-90’ targets for adolescents.</description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000001513</identifier><identifier>PMID: 28665879</identifier><language>eng</language><publisher>England: Copyright Wolters Kluwer Health, Inc</publisher><subject>Adolescent ; Adult ; AIDS/HIV ; Diagnostic Services ; Diagnostic Tests, Routine - methods ; Female ; HIV Infections - diagnosis ; Humans ; Interviews as Topic ; Kenya ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Supplement</subject><ispartof>AIDS (London), 2017-07, Vol.31 Suppl 3 (Supplement 3), p.S213-S220</ispartof><rights>Copyright © 2017 Wolters Kluwer Health, Inc.</rights><rights>Copyright © 2017 The Author(s). 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Caregivers universally supported adolescent testing, including testing with the adolescent to demonstrate support. Caregivers relied on HCWs to inform and encourage adolescents. Although peers played less significant roles during testing, all groups agreed that school-based outreach could increase peer demand and counteract stigma. All groups recognized tensions around adolescent autonomy in the absence of clear consent guidelines. Adolescents valued support people during testing but wanted autonomy over testing and disclosure decisions. HCWs felt pressured to defer consent to caregivers. Caregivers wanted to know results regardless of adolescents’ wishes. 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Better understanding of adolescent, provider, and caregiver experiences in high-burden countries such as Kenya could improve adolescent HIV testing programs. DESIGN:We conducted 16 qualitative interviews with HIV-positive and HIV-negative adolescents (13–18 years) and six focus group discussions with Healthcare workers (HCWs) and caregivers of adolescents in Nairobi, Kenya. METHODS:Semi-structured interviews and focus groups were recorded and transcribed. Analysis employed a modified constant comparative approach to triangulate findings and identify themes influencing testing experiences and practices. RESULTS:All groups identified that supportive interactions during testing were essential to the adolescentʼs positive testing experience. HCWs were a primary source of support during testing. HCWs who acted respectful and informed helped adolescents accept results, link to care, or return for repeat testing, whereas HCWs who acted dismissive or judgmental discouraged adolescent testing. Caregivers universally supported adolescent testing, including testing with the adolescent to demonstrate support. Caregivers relied on HCWs to inform and encourage adolescents. Although peers played less significant roles during testing, all groups agreed that school-based outreach could increase peer demand and counteract stigma. All groups recognized tensions around adolescent autonomy in the absence of clear consent guidelines. Adolescents valued support people during testing but wanted autonomy over testing and disclosure decisions. HCWs felt pressured to defer consent to caregivers. Caregivers wanted to know results regardless of adolescents’ wishes. 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identifier ISSN: 0269-9370
ispartof AIDS (London), 2017-07, Vol.31 Suppl 3 (Supplement 3), p.S213-S220
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language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5497781
source MEDLINE; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals
subjects Adolescent
Adult
AIDS/HIV
Diagnostic Services
Diagnostic Tests, Routine - methods
Female
HIV Infections - diagnosis
Humans
Interviews as Topic
Kenya
Male
Middle Aged
Patient Acceptance of Health Care
Supplement
title “At our age, we would like to do things the way we want: ” a qualitative study of adolescent HIV testing services in Kenya
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