Cargando…

Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study

BACKGROUND: Kenyan adolescent girls and young women (AGYW) experience a dual burden of HIV and common mental disorders (CMD). HIV clinics are a key entry point for AGYW in need of integrated CMD and HIV care; however, rates of screening and referral for CMDs are low. Our objective was to test an evi...

Descripción completa

Detalles Bibliográficos
Autores principales: Concepcion, Tessa, Mogere, Peter, Ngure, Kenneth, Mwathi, Njoroge, Njiru, Roy, Kipkorir, Boaz, Kiptinness, Catherine, Maina, Gakuo, Owidi, Emmah, Owens, Tamara, Kohler, Pamela, Wagenaar, Bradley H., Dorsey, Shannon, Collins, Pamela Y., Velloza, Jennifer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10556463/
https://www.ncbi.nlm.nih.gov/pubmed/37808984
http://dx.doi.org/10.3389/fpubh.2023.1209525
_version_ 1785116876876021760
author Concepcion, Tessa
Mogere, Peter
Ngure, Kenneth
Mwathi, Njoroge
Njiru, Roy
Kipkorir, Boaz
Kiptinness, Catherine
Maina, Gakuo
Owidi, Emmah
Owens, Tamara
Kohler, Pamela
Wagenaar, Bradley H.
Dorsey, Shannon
Collins, Pamela Y.
Velloza, Jennifer
author_facet Concepcion, Tessa
Mogere, Peter
Ngure, Kenneth
Mwathi, Njoroge
Njiru, Roy
Kipkorir, Boaz
Kiptinness, Catherine
Maina, Gakuo
Owidi, Emmah
Owens, Tamara
Kohler, Pamela
Wagenaar, Bradley H.
Dorsey, Shannon
Collins, Pamela Y.
Velloza, Jennifer
author_sort Concepcion, Tessa
collection PubMed
description BACKGROUND: Kenyan adolescent girls and young women (AGYW) experience a dual burden of HIV and common mental disorders (CMD). HIV clinics are a key entry point for AGYW in need of integrated CMD and HIV care; however, rates of screening and referral for CMDs are low. Our objective was to test an evidence-based provider training strategy, simulated patient encounters (SPEs), on CMD service delivery for AGYW in a Kenyan HIV clinic. METHODS: This pilot study was conducted in a public HIV clinic in Thika, Kenya from January to November 2021. The simulated patient encounter (SPE) implementation strategy included case script development from prior qualitative work, patient actor training, and a three-day SPE training including four standardized mock clinical encounters followed by quantitative surveys assessing provider competencies for each encounter. We abstracted medical record data related to HIV and CMDs such as HIV status, reason for visit, CMD screening test performed, and counselling or referral information. We conducted an interrupted time series analysis using abstracted HIV and CMD screening rates from AGYW ages 16–25 years visiting the clinic 7 months before and 3 months after SPE training. We used generalized linear models to assess changes in CMD screening rates after training. RESULTS: A total of 10 providers participated in the training. Competency ratings improved across four mock encounters (mean score from 8.1 to 13.7) between first and fourth encounters. We abstracted all medical records (n = 1,154) including from 888 (76%) AGYW seeking HIV treatment, 243 (21%) seeking prevention services, and 34 (3%) seeking other services. CMD screening rates increased immediately following training from 8 to 21% [relative risk (RR) = 2.57, 95% confidence interval (CI) = 1.34–4.90, p < 0.01]. The 3 months following the SPE training resulted in an 11% relative increase in CMD screening proportion compared to the 7 months pre-SPE (RR: 1.11, 95% CI: 1.04–1.17, p < 0.01). Finally, 1% of all pre-SPE screens resulted in referral versus 5% of post-SPE screens (p = 0.07). CONCLUSION: The SPE model is a promising implementation strategy for improving HIV provider competencies and CMD service delivery for adolescents in HIV clinics. Future research is needed to explore effects on adolescent clinical outcomes in larger trials.
format Online
Article
Text
id pubmed-10556463
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-105564632023-10-07 Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study Concepcion, Tessa Mogere, Peter Ngure, Kenneth Mwathi, Njoroge Njiru, Roy Kipkorir, Boaz Kiptinness, Catherine Maina, Gakuo Owidi, Emmah Owens, Tamara Kohler, Pamela Wagenaar, Bradley H. Dorsey, Shannon Collins, Pamela Y. Velloza, Jennifer Front Public Health Public Health BACKGROUND: Kenyan adolescent girls and young women (AGYW) experience a dual burden of HIV and common mental disorders (CMD). HIV clinics are a key entry point for AGYW in need of integrated CMD and HIV care; however, rates of screening and referral for CMDs are low. Our objective was to test an evidence-based provider training strategy, simulated patient encounters (SPEs), on CMD service delivery for AGYW in a Kenyan HIV clinic. METHODS: This pilot study was conducted in a public HIV clinic in Thika, Kenya from January to November 2021. The simulated patient encounter (SPE) implementation strategy included case script development from prior qualitative work, patient actor training, and a three-day SPE training including four standardized mock clinical encounters followed by quantitative surveys assessing provider competencies for each encounter. We abstracted medical record data related to HIV and CMDs such as HIV status, reason for visit, CMD screening test performed, and counselling or referral information. We conducted an interrupted time series analysis using abstracted HIV and CMD screening rates from AGYW ages 16–25 years visiting the clinic 7 months before and 3 months after SPE training. We used generalized linear models to assess changes in CMD screening rates after training. RESULTS: A total of 10 providers participated in the training. Competency ratings improved across four mock encounters (mean score from 8.1 to 13.7) between first and fourth encounters. We abstracted all medical records (n = 1,154) including from 888 (76%) AGYW seeking HIV treatment, 243 (21%) seeking prevention services, and 34 (3%) seeking other services. CMD screening rates increased immediately following training from 8 to 21% [relative risk (RR) = 2.57, 95% confidence interval (CI) = 1.34–4.90, p < 0.01]. The 3 months following the SPE training resulted in an 11% relative increase in CMD screening proportion compared to the 7 months pre-SPE (RR: 1.11, 95% CI: 1.04–1.17, p < 0.01). Finally, 1% of all pre-SPE screens resulted in referral versus 5% of post-SPE screens (p = 0.07). CONCLUSION: The SPE model is a promising implementation strategy for improving HIV provider competencies and CMD service delivery for adolescents in HIV clinics. Future research is needed to explore effects on adolescent clinical outcomes in larger trials. Frontiers Media S.A. 2023-09-22 /pmc/articles/PMC10556463/ /pubmed/37808984 http://dx.doi.org/10.3389/fpubh.2023.1209525 Text en Copyright © 2023 Concepcion, Mogere, Ngure, Mwathi, Njiru, Kipkorir, Kiptinness, Maina, Owidi, Owens, Kohler, Wagenaar, Dorsey, Collins and Velloza. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Concepcion, Tessa
Mogere, Peter
Ngure, Kenneth
Mwathi, Njoroge
Njiru, Roy
Kipkorir, Boaz
Kiptinness, Catherine
Maina, Gakuo
Owidi, Emmah
Owens, Tamara
Kohler, Pamela
Wagenaar, Bradley H.
Dorsey, Shannon
Collins, Pamela Y.
Velloza, Jennifer
Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study
title Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study
title_full Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study
title_fullStr Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study
title_full_unstemmed Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study
title_short Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study
title_sort higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a kenyan hiv clinic: results of a pilot study
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10556463/
https://www.ncbi.nlm.nih.gov/pubmed/37808984
http://dx.doi.org/10.3389/fpubh.2023.1209525
work_keys_str_mv AT concepciontessa higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT mogerepeter higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT ngurekenneth higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT mwathinjoroge higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT njiruroy higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT kipkorirboaz higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT kiptinnesscatherine higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT mainagakuo higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT owidiemmah higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT owenstamara higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT kohlerpamela higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT wagenaarbradleyh higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT dorseyshannon higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT collinspamelay higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy
AT vellozajennifer higherratesofmentalhealthscreeningofadolescentsrecordedafterprovidertrainingusingsimulatedpatientsinakenyanhivclinicresultsofapilotstudy