L A Enane1, J Eby2, T Arscott-Mills3, S Argabright4, C Caiphus5, B Kgwaadira5, A P Steenhoff6, E D Lowenthal7. 1. Division of Infectious Diseases, Botswana-UPenn Partnership, Gaborone, Botswana. 2. Department of Pediatrics, Boston Children's Hospital and Department of Medicine, Brigham and Women's Hospital, Boston, MA. 3. Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, University of Pennsylvania Perelman School of Medicine. 4. University of Pennsylvania, Philadelphia, PA, USA. 5. Botswana National TB Programme, Ministry of Health, Gaborone, Botswana. 6. Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, University of Pennsylvania Perelman School of Medicine. 7. Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Abstract
SETTING: Nine high-burden public tuberculosis (TB) clinics in Gaborone, Botswana. OBJECTIVE: To evaluate the challenges encountered, healthcare worker (HCW) approaches, and supported interventions in TB and TB-HIV (human immunodeficiency virus) care for adolescents and young adults (AYA, aged 10-24 years). DESIGN: Semi-structured interviews with HCW in TB clinics, analyzed using thematic analysis. RESULTS: Sixteen HCWs were interviewed. AYA developmental needs included reliance on family support for care, increasing autonomy, attending school or work, building trust in HCWs, and intensive TB education and adherence support. Stigma strongly influenced care engagement, including clinic attendance and HIV testing. Health system barriers to optimal AYA TB care included limited staffing and resources to follow-up or support. HCWs utilized intensive education and counseling, and transitioned AYA to community-based directly observed therapy whenever feasible. HCWs supported implementation of youth-friendly services, such as AYA-friendly spaces or clinic days, training in AYA care, use of mobile applications, and peer support interventions, in addition to health system strengthening. CONCLUSION: HCWs utilize dedicated approaches for AYA with TB, but have limited time and resources for optimal care. They identified several strategies likely to improve care and better retain AYAs in TB treatment. Further work is needed to study interventions to improve AYA TB care and outcomes.
SETTING: Nine high-burden public tuberculosis (TB) clinics in Gaborone, Botswana. OBJECTIVE: To evaluate the challenges encountered, healthcare worker (HCW) approaches, and supported interventions in TB and TB-HIV (human immunodeficiency virus) care for adolescents and young adults (AYA, aged 10-24 years). DESIGN: Semi-structured interviews with HCW in TB clinics, analyzed using thematic analysis. RESULTS: Sixteen HCWs were interviewed. AYA developmental needs included reliance on family support for care, increasing autonomy, attending school or work, building trust in HCWs, and intensive TB education and adherence support. Stigma strongly influenced care engagement, including clinic attendance and HIV testing. Health system barriers to optimal AYA TB care included limited staffing and resources to follow-up or support. HCWs utilized intensive education and counseling, and transitioned AYA to community-based directly observed therapy whenever feasible. HCWs supported implementation of youth-friendly services, such as AYA-friendly spaces or clinic days, training in AYA care, use of mobile applications, and peer support interventions, in addition to health system strengthening. CONCLUSION: HCWs utilize dedicated approaches for AYA with TB, but have limited time and resources for optimal care. They identified several strategies likely to improve care and better retain AYAs in TB treatment. Further work is needed to study interventions to improve AYA TB care and outcomes.
Authors: Susan M Sawyer; Rima A Afifi; Linda H Bearinger; Sarah-Jayne Blakemore; Bruce Dick; Alex C Ezeh; George C Patton Journal: Lancet Date: 2012-04-25 Impact factor: 79.321
Authors: Russell M Viner; Elizabeth M Ozer; Simon Denny; Michael Marmot; Michael Resnick; Adesegun Fatusi; Candace Currie Journal: Lancet Date: 2012-04-25 Impact factor: 79.321
Authors: Lana Lee; Baligh R Yehia; Aditya H Gaur; Richard Rutstein; Kelly Gebo; Jeanne C Keruly; Richard D Moore; Ank E Nijhawan; Allison L Agwu Journal: AIDS Patient Care STDS Date: 2016-03-16 Impact factor: 5.078
Authors: L A Enane; E D Lowenthal; T Arscott-Mills; M Matlhare; L S Smallcomb; B Kgwaadira; S E Coffin; A P Steenhoff Journal: Int J Tuberc Lung Dis Date: 2016-10 Impact factor: 2.373
Authors: Kathryn J Snow; Charalambos Sismanidis; Justin Denholm; Susan M Sawyer; Stephen M Graham Journal: Eur Respir J Date: 2018-02-21 Impact factor: 16.671
Authors: K M Laycock; J Eby; T Arscott-Mills; S Argabright; C Caiphus; B Kgwaadira; E D Lowenthal; A P Steenhoff; L A Enane Journal: Int J Tuberc Lung Dis Date: 2021-07-01 Impact factor: 3.427
Authors: Patricia Moscibrodzki; Leslie A Enane; Graeme Hoddinott; Meredith B Brooks; Virginia Byron; Jennifer Furin; James A Seddon; Lily Meyersohn; Silvia S Chiang Journal: Pathogens Date: 2021-12-08