Simulated Patient Encounters to Promote Early Detection and Engagement in HIV Care for Adolescents

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 DESCRIPTION (provided by applicant): Despite enormous expansion of HIV testing and treatment services in resource-limited settings, adolescents continue to be disproportionately affected by HIV. In 2013, UNAIDS reported that adolescents between the ages of 15-24 have the highest HIV incidence rates compared to any other age strata. And while mortality has decreased in adult and pediatric populations, there has been a 50% increase in adolescent HIV-related deaths over the last 7 years. Inadequate provision of accessible and acceptable HIV testing, counseling, and treatment services has been cited as a barrier to uptake of and retention in HIV care among adolescents. Additionally, in preliminary studies by our group, health care workers tasked with providing adolescent HIV services frequently reported feeling inadequately prepared to cope with the needs of this age group. Primarily used in medical education, simulated patient (SP) encounters show great promise as a mechanism for health care workers in low-resource settings to improve critical decision-making, patient interaction, and communication skills. These encounters serve not only to provide teaching and mentorship where a trained actor and a faculty observer can provide immediate feedback and support to the clinician, but also provide quantitative and qualitative measures of clinical performance and competency that can be compared to clinical outcomes. We hypothesize that SP encounters will increase provider confidence and capacity to facilitate HIV status disclosure and provide supportive interactions with HIV-infected youth, which will in turn increase uptake and improve retention in HIV services among adolescents. We propose to develop and evaluate a clinical training intervention utilizing standardized patient actors to improve communication and interpersonal skills of health care workers in working with adolescents, resulting in increased engagement in HIV care. In AIM 1, we will develop patient case scripts specific to adolescent HIV- related care and counseling needs in Kenya and establish the number of training interactions necessary to reach competency. AIM 2 is a cluster randomized controlled stepped-wedge trial assessing the impact of SP encounters on the proportion of adolescent patients retained in care at public HIV treatment facilities in Kenya. In AIM 3 we will determine the cost effectiveness of the SP intervention. These data will contribute valuable information to HIV programs in Kenya and other low-resource settings, providing a potentially scalable strategy to improve adolescent linkage to and retention in critical HIV services.