Adolescent Coordinated Transition (ACT) to improve health outcomes among young people living with HIV in Nigeria: Study protocol for a randomized controlled trial

Nadia A. Sam-Agudu, Jennifer R. Pharr, Tamara Bruno, Chad L. Cross, Llewellyn J. Cornelius, Prosper Okonkwo, Bolanle Oyeledun, Hadiza Khamofu, Ayodotun Olutola, Salome Erekaha, William Nii Ayitey Menson, Echezona E. Ezeanolue

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Adolescents living with HIV (ALHIV) have worse health outcomes than other populations of people living with HIV. Contributing factors include lack of standard and comprehensive procedures for ALHIV transitioning from pediatric to adult care. This has contributed to poor retention at, and following transition, which is problematic especially in high ALHIV-burden, resource-limited settings like Nigeria. Methods: Using a two-arm cluster randomized control design, the Adolescent Coordinated Transition (ACT) trial will measure the comparative effectiveness of a graduated transition and organized support group intervention against the usual practice of abrupt transfer of Nigerian ALHIV from pediatric to adult care. This study will be conducted at 12 secondary and tertiary healthcare facilities (six intervention, six control) across all six of Nigeria's geopolitical zones. The study population is 13- to 17-year-old ALHIV (N = 216, n = 108 per study arm) on antiretroviral therapy. Study participants will be followed through a 12-month pre-transfer/transition period and for an additional 24 months post transfer/transition. The primary outcome measure is the proportion of ALHIV retained in care at 12 and 24 months post transfer. Secondary outcome measures are proportions of ALHIV achieving viral suppression and demonstrating increased psychosocial wellbeing and self-efficacy measured by psychometric tests including health locus of control, functional social support, perceived mental health, and sexual risk and behavior. Discussion: We hypothesize that the ACT intervention will significantly increase psychosocial wellbeing, retention in care and ultimately viral suppression among ALHIV. ACT's findings have the potential to facilitate the development of standard guidelines for transitioning ALHIV and improving health outcomes in this population. The engagement of a consortium of local implementing partners under the Nigeria Implementation Science Alliance allows for nationwide study implementation and expedient results dissemination to program managers and policy-makers. Ultimately, ACT may also provide evidence to inform transitioning guidelines not only for ALHIV but for adolescents living with other chronic diseases in resource-limited settings. Trial registration:, ID: NCT03152006. Registered on May 12, 2017.

Original languageEnglish (US)
Article number595
Issue number1
StatePublished - Dec 14 2017
Externally publishedYes

Bibliographical note

Funding Information:
The ACT trial is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD089871 to EEE and NASA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding agencies played no role in the study conception or design and will not play a role in data collection, data analysis, data interpretation, or writing of the report.

Publisher Copyright:
© 2017 The Author(s).


  • Adolescent
  • Healthcare transition
  • HIV
  • Mental health
  • Nigeria
  • Retention
  • Viral suppression


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