SEARCHCOHORTpsychiatry, public health

cohort·psychiatry, public health, epidemiology, pediatrics, family medicine·PMC10556463

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

Frontiers in Public Health · 15 authors, 9 centres

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This interrupted time series cohort study evaluated a provider training intervention using simulated patient encounters (SPEs) in a public HIV clinic in Kenya.

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This interrupted time series cohort study evaluated a provider training intervention using simulated patient encounters (SPEs) in a public HIV clinic in Kenya. The study abstracted 1,154 medical records for visits by patients aged 16–25, analyzing screening rates for 7 months before and 3 months after the 3-day training. The proportion of visits with screening rose from 15% pre-training to 33% post-training.

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cohort

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psychiatry

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AI pipeline

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ORIGINAL PAPER

PMC10556463

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

Frontiers in Public Health

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ABSTRACT

Abstract 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. Keywords: HIV, global mental health, simulated patient encounters, service integration, implementation strategies, Kenya, adolescents and young adults

CITATION EXPORT

Tessa Concepcion, Peter Mogere, Kenneth Ngure et al.. 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. Frontiers in Public Health. (2023). https://doi.org/10.3389/fpubh.2023.1209525

AUTHORS

15 · 9 CENTRES

Tessa Concepcion, Peter Mogere, Kenneth Ngure, Njoroge Mwathi, Roy Njiru, Boaz Kipkorir, Catherine Kiptinness, Gakuo Maina, Emmah Owidi, Tamara Owens, Pamela Kohler, Bradley H Wagenaar, Shannon Dorsey, Pamela Y Collins, Jennifer Velloza

1Department of Global Health, University of Washington, Seattle, WA, United States
2Partners in Health and Research Development, Thika, Kenya
3School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
4Simulation and Clinical Skills Center, Howard University, Washington, DC, United States
5Department of Child, Family, and Population Health Nursing, Seattle, WA, United States
6Department of Epidemiology, University of Washington, Seattle, WA, United States
7Department of Psychology, University of Washington, Seattle, WA, United States
8Department of Psychiatry, University of Washington, Seattle, WA, United States
9Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States