Browsing by Author "Mbebe, Sylvie"
Now showing 1 - 1 of 1
Results Per Page
Sort Options
- ItemBarriers to and facilitators of the transition to adult care among HIV-infected youth in the Western Cape(Stellenbosch : Stellenbosch University., 2020-03) Mbebe, Sylvie; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.ENGLISH ABSTRACT: Background. South Africa has the highest rate of HIV-infection in the world, and with nearly one-third of all new HIV-infections occurring in the age group 15−24 years, adolescents and young people bear the burden of this disease. As children and young people move through their developmental stages, those living with chronic illnesses also move through the healthcare system, transitioning from paediatric services to adult services. Ideally, when those receiving paediatric care reach late adolescence (15–19 years) or early adulthood (19–25 years), they should transfer to adult care so that they can start managing their own health. However, in resource-limited settings like South Africa, little is understood of the transition process and the factors that may contribute to or hinder the process. As such, the aim of this study was to explore the barriers to and the facilitators of transition to adult HIV care among HIV-infected youths in the Western Cape from the perspectives of healthcare providers who provide paediatric and adult HIV healthcare services. Methods. I used purposive sampling methods to recruit participants for this study. Data gathering included in-depth, semi-structured interviews with 24 healthcare providers (pharmacists (n=7), doctors (n=3), nurses (n=8), sisters (n=2), counsellors (n=1)) and three additional hospital staff (one data capturer and two administrative clerks). The interviews were audio-recorded and transcribed verbatim for the purposes of thematic analysis. I analysed the data using ATLAS.ti computer software. Further, I used an observation schedule to document the moment-by-moment occurrences in the patient waiting rooms of the two healthcare facilities included in this study. Results. Four themes and 10 subthemes that captured participants’ sentiments on the barriers to and facilitators of transition to adult care emerged from the data. The four themes were (1) understanding and conceptualization of transition; (2) individual factors affecting transition; (3) healthcare system factors affecting transition; and (4) social factors affecting transition. Participants understood transition to mean different things, including a change in the medication regimen, a change of clinic or a change of doctor. Some were not familiar with the term. Barriers to transition included a lack of transition readiness, the unfriendly clinic environment, services gaps, a lack of knowledge about HIV, a lack of communication, adolescents’ developmental stage, home environments and broad contextual issues (such as poverty and inequality, the breakdown of family, and stigma). Further issues were related to service provision, such as inadequate resources in the clinic, insufficient training, lack of policies, and fragmented services. Participants suggested that an increase in the number of healthcare professionals and the employment of younger staff could be of benefit. They also suggested that training and preparatory programmes could provide adolescents with adequate support and prepare them for transition. Participants furthermore proposed ongoing individual counselling sessions for transitioning adolescents as well as a tracking system for defaulters from adult clinics. Others suggestions included the creation of youth-friendly clinics with integrated healthcare systems only for youths; training of healthcare providers in adolescent medicine, and the creation of centres and programmes for youths in their communities. Participants also highlighted the importance of the implementation of continuous HIV awareness programmes and resources for HIV-infected youths and their families. Conclusion. The findings from this study demonstrate that the transition to adult care is not always easy. Understanding the barriers to and facilitators of the transition to adult care will help guide informed initiatives and strategies that can improve the transition process from the paediatric to the adult healthcare setting. Targeting the needs of adolescents during the process of transition has the potential to improve adolescents’ adherence to treatment and to promote long-term health outcomes.