Feasibility, Acceptability, and Effectiveness of a Peer Youth Leader Model to Deliver a HIV Curriculum in Routine HIV Adolescent Clinic and Impact on Youth Leader Resilience: a Mixed-Methods Study

Abstract

Background: Youth living with HIV have worse health outcomes compared to adults or children. Few interventions have been developed engaging youth in their care to promote resilience. Peer-led education is one potential way to boost confidence and bolster resilience while also improving HIV knowledge of youth living with HIV (YLHIV). Peer youth leaders (PYL) can be effective educators because they are seen as trustworthy and relatable to their peers. PYL themselves may also benefit from increased resilience and empowerment after taking on leadership position at their monthly adolescent HIV clinic. This study evaluated the acceptability, feasibility, and effectiveness of using PYL to teach an HIV education. Methods: Seven HIV-infected youth were recruited based on their previous enrollment in a mental health intervention for HIV-infected youth. Those who demonstrated confidence, excellent adherence, and upstanding behavior were chosen to become PYL. PYLs were trained by a doctor, social worker, and previously trained group leaders of a mental health intervention to teach an HIV education curriculum adapted from the Baylor International Pediatric AIDS Initiative. Trainings occurred once a week for two to three hours in preparation for teaching at the monthly adolescent HIV clinic. Two PYLs taught one-hour lessons to youth during the monthly adolescent HIV clinic. Approximately 25 clinic attendees were asked to volunteer to complete pre/post knowledge assessments and provided feedback on the PYL model. Acceptability and feasibility of using PYL to deliver an HIV curriculum to YLHIV was evaluated through attendance records, fidelity checklists and feedback notes that were documented by trained group leaders who supervised PYL curriculum delivery. In depth interviews were conducted to evaluate change in fears, motivations, and resilience among PYL before and after assuming the leadership role. PYL resilience was measured using the Connor-Davidson Scale at baseline (prior to starting the teaching role) and 6 months after initiating training. Results: A PYL model of delivering an HIV curriculum was both feasible and acceptable as reported by youth attending monthly adolescent HIV clinic and PYL. Qualitative findings showed peer education created safe discussion spaces, reduced stress of participants, and enhanced beliefs of importance in maintaining good adherence. HIV knowledge was improved as measured by self-report, and improvement did not meet statistical significant (p =0.057). PYL leaders demonstrated trends toward improved resilience as measured by Connor-Davidson Resilience Scale and increased confidence, feelings of self-worth, sense of purpose, social support, and optimism and decreased internal stigma based on in-depth interviews. Conclusions: Results demonstrated the PYL model of teaching an HIV curriculum was feasible and acceptable. PYL had improved resilience as a result of taking on a leadership role at their monthly adolescent HIV clinic. Future evaluation of YLHIV retention in care and health outcomes as a result of participation in the PYL education should be explored.