Study Setting
Data collection was conducted at the Paediatric and Adolescent HIV Clinic of Baylor College of Medicine Children’s Foundation Uganda, in Kampala district, between August and November 2019. The clinic is a teaching and research institution providing educational opportunities for professionals at Makerere University College of Health Sciences and other healthcare training institutions. The clinic has five paediatric-adolescent service units (clinical care unit, nutrition unit, counselling unit, psychosocial services unit, play therapy and drama unit) and an estimated 4,517 YLHIV receiving HIV care and treatment services (clinical data, 2019). The Baylor-Uganda HIV Clinic was chosen as the site for this study because it is a clinical centre of excellence (CCE), has a high patient census, often with multicomplex medical, psychological and socioeconomic issues that require a higher level of care and attention, including the provision of intensive counselling sessions, health education, nutritional support, peer support activities and training opportunities in income-generating skills. Kampala district is a capital city in the central region of Uganda.
Study Design
This was a cross-sectional and analytical study involving a simple random sample of 267 YLHIV whose data were captured using a semistructured interviewer-administered questionnaire adopted and modified by the authors from the HLS-EU questionnaire to suit the study population.
The research assistants (RAs) were all Ugandan nationals residing in Kampala district with clinical research experience. The research assistants participated in five days of interactive training on all the study components, including a detailed review of the questions to ensure a shared understanding of the survey material. The RAs interviewed the 267 YLHIV in the youth’s usual clinic context (on their respective routine clinic visit appointment days).
Participants and Recruitment
The following eligibility criteria for inclusion in the study were set to obtain the required sample: having been in care at the HIV clinic of Baylor College of Medicine Children’s Foundation Uganda for at least 12 months and having given written informed consent or assent to participate.
The reasons for excluding any potential participant included severe cognitive impairment whereby an individual is unable to answer interview questions and nondisclosure of one’s HIV sero status because of fear of accidental disclosure while interviewing youth on HIV-related content.
The study received approval from both local and international institutional review boards (IRBs). Additionally, permission was obtained from the Department of Research, Baylor College of Medicine Children’s Foundation Uganda. Written consent and assent were obtained from YLHIV prior to participation in this study.
Sample Size Estimation
Using Yamane (1967) formula [22]: n = N / (1 + Ne^2)
where
- n = required sample size
- e = error limit/level of precision (in this study, it is 5%)
- N = the size of the target population (in this study, the prospective average monthly population of YLHIV with clinic appointments over 4 months from 15 July 2019 onwards was estimated at 606.75)
Placing information in the formula above at a 95% confidence level and an error limit of 5% revealed that the required sample size was 241 participants.
However, to account for possible nonresponse (estimated at 10%), the number of subjects was increased to 268 using the following formula: Final sample size = Effective sample size divided by (1- Nonresponse rate anticipated).
During data collection, one respondent did not answer 80% of the questions in each of the four questionnaire components of access, comprehension, appraisal and application of SRH information and hence was not included in the final analysis.
Data Collection Procedure and Sampling
A simple random sampling technique was used to select youth in this study. The simple random sample was first obtained in Microsoft Excel using the RAND function and sorting from the smallest to the largest randomly numbered participants from the initial Baylor-Uganda Electronic Medical Records (EMR) list of youth. The list obtained from the data department of Baylor-Uganda comprised only youth with clinic appointments falling in the planned data collection period (July to November 2019). During data collection, three trained research assistants (RAs) subsequently tracked and identified potential respondents from the waiting area using the final EMR-generated list of 268 randomly obtained samples of youth with appointment date information. The RAs then approached, greeted and briefed individual youth about the study procedure and significance to obtain their informed verbal and written assent or consent. Those who agreed to participate in the study were interviewed by the RAs in clinical examination rooms for an estimated average time of 45 minutes. To avoid interrupting patient care, youth were typically, although not always, targeted during tea and lunch breaks and after they had been seen through routine clinical procedures. The interviewer-administered semistructured questionnaire was developed based on a literature review and modified using the HLS-EU questionnaire to suit this study population.
The questionnaire had three parts: Part A (with 20 questions on sociodemographic/personal characteristics), Part B (with 26 questions on environmental factors presumed to be related to youth SRH literacy), and Part C (with 4 subsections on access, understanding, appraisal and application of SRH information with a total of 39 Likert-scale questions used to compute levels of SRH literacy). The personal characteristics included age, sex, ethnicity, religion, marital status and level of education of the youth. Other presumed factors included knowledge about SRH issues, attitudes and beliefs about SRH issues, such as belief in the possibility of an AIDS-free generation. Patient-specific factors included viral load status, visual status, auditory status, mental health status, and employment status. Environmental factors such as the existence of provider-initiated comprehension evaluation efforts, channels of health communication, school location, availability and accessibility to SRH service points, family characteristics such as type, parental existence, frequency of stay with parents, existence of family health talks, and employment status of parents/guardians were also considered.
The content in Part C focused on five selected SRH issues related to HIV transmission in this population, i.e., STI/STDs, contraception, pregnancy and childbirth, breastfeeding, and adherence to ART.
Two adolescent experts reviewed the questionnaire before data collection, and their input was incorporated into the final version. A pilot study was conducted comprising 20 YLHIV (10 boys and 10 girls) from another urban teenage health centre; the questionnaire was adjusted and finalized for use
SDGs, Targets, and Indicators
SDGs Addressed or Connected to the Issues Highlighted in the Article:
- SDG 3: Good Health and Well-Being
- SDG 4: Quality Education
- SDG 5: Gender Equality
- SDG 10: Reduced Inequalities
Specific Targets Under Those SDGs Based on the Article’s Content:
- SDG 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.
- SDG 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.
- SDG 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
- SDG 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
Indicators Mentioned or Implied in the Article:
- Number of youth living with HIV receiving care and treatment services
- Number of youth with clinic appointments
- Percentage of youth with severe cognitive impairment
- Percentage of youth disclosing their HIV sero status
- Number of participants in the study
- Percentage of nonresponse rate anticipated
- Cronbach’s alpha coefficient of internal consistency for SRH literacy items
- SRH literacy scores based on the HLS-EU index
- Frequencies and percentages of descriptive results
- Odds ratios to estimate the likelihood of youth being health literate on SRH issues
Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-Being | SDG 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases. | – Number of youth living with HIV receiving care and treatment services – Percentage of youth with severe cognitive impairment – Percentage of youth disclosing their HIV sero status |
| SDG 4: Quality Education | SDG 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development. | – Number of youth with clinic appointments – Number of participants in the study |
| SDG 5: Gender Equality | SDG 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences. | – SRH literacy scores based on the HLS-EU index – Odds ratios to estimate the likelihood of youth being health literate on SRH issues |
| SDG 10: Reduced Inequalities | SDG 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status. | – Frequencies and percentages of descriptive results |
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Source: bmcpublichealth.biomedcentral.com
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