Strategy to optimize the transition of adolescents living with HIV to Adulthood at selected districts in Limpopo Province, South Africa

Abstract

Background: Babies born with Human Immunodeficiency Virus (HIV) in the first decade of the epidemic have reached adolescents stage. As they are growing up, they experience events like all adolescents, irrespective of routines imposed on them by living with the virus. These Adolescents Living with Human Immunodeficiency Virus (ALWHIV) need specialized care to cope with illnesses which could result from the side effects of the medications. Purpose: This study sought to develop a strategy to optimize the transition of ALWHIV to adulthood at selected districts in Limpopo Province. The study was conducted in three phases. Phase 1 was empirical with the following objectives: to explore and describe the knowledge of ALWHIV during transition to adulthood, to describe challenges faced by parents/guardians during the transition to adulthood, to explore the support given to ALWHIV by parents/guardians during the transition to adulthood. Phase 2 focused on strategy development, i.e., to develop a strategy to optimize the transition of ALWHIV to adulthood and phase 3 focused on validation strategy, i.e. to conduct validation of the developed strategy. Methods: The study took a qualitative research approach which involved exploratory, descriptive, and contextual designs. The population comprised of ALWHIV and parents or guardians who live with and care for these children. Non-probability purposive sampling was used to sample ALWHIV and their parents or guardians. The sample size was 27 participants who enrolled for antiretroviral therapy (ART) care and 18 parents or guardians of these children. Measures to ensure trustworthiness articulated in Lincoln and Guba’s criteria and ethical considerations were adhered to. Data were collected using in-depth interviews with both groups and analysed through Tesch’s open-coding method. Findings: The following 5 themes emerged from the qualitative data analysis: Descriptions of the experiences of ALWHIV; Challenges experienced from childhood to adolescence period; Descriptions of existing support experiences by ALWHIV and their parents; Knowledge related to HIV+ status and disease progression; and Suggestions made to promote quality of life by ALWHIV. Upon further analysis, these five themes yielded 24 sub-themes. The findings of the empirical (phase 1) were used to develop a strategy using Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis (phase 2). From the SWOT analysis, SWOT matrix emerged and strategy (actionable plans) classified in Building on the strengths, Overcoming weaknesses, Exploring the opportunities and Minimizing the threats (BOEM) was developed. The developed strategy was validated by professional nurses using a qualitative design. Results of validation: The developed strategy was considered to be good and easy to implement in order to optimize the transition of ALWHIV, but will not be generalized because the study could not cover the whole of Limpopo Province. The strategy will be implemented in the primary health care (PHC) facilities where the study was conducted in the selected districts of Limpopo. The developed strategy could contribute greatly when preparing ALWHIV for transition so that they remain in care until a cure is found. Recommendations: The study recommendations were made with reference to nursing practice, nursing education and research. The recommendations may contribute and assist NIMART nurses during the preparations for transition of ALWHIV to adulthood and policymakers in the district or province during the updates of adolescents on HIV guidelines or policies.