Adaptation and validation of the STARx for Ugandan adolescents

Transitioning from pediatric to adult care is a significant challenge in Uganda, where over 170,000 young people living with HIV (YPLHIV) require continuous HIV care. Assessment of adolescents' readiness to transition is a keystone of developmentally appropriate care. This study aimed to adapt and validate the Self-Management and Transition to Adulthood with Rx = Treatment (STARx) measurement tool for Ugandan YPLHIV.

The STARx tool was adapted for the Ugandan context through cognitive interviews with 10 YPLHIV (ages 15-20), leading to revisions in the tool's structure and language. The adapted STARx-Uganda tool was then validated with 154 YPLHIV. Data were collected using electronic tablets and analyzed through exploratory factor analysis and reliability testing.The validation process included assessing the tool's psychometric properties, including internal consistency, factor structure, and concurrent validity.

The STARx-Uganda tool was found to have satisfactory internal consistency (Cronbach's alpha = 0.73). Factor analysis revealed a five-factor model: Provider Communication, Disease Knowledge, Self-Management, Medication Management and Engagement during Appointments. The tool demonstrated concurrent validity, with higher readiness scores associated with better healthcare utilization, including fewer missed appointments and better adherence to antiretroviral therapy. Notably, the Self-Management subscale was consistently correlated with both healthcare utilization outcomes.

The findings support the STARx-Uganda as a reliable and valid tool for assessing transition readiness among YPLHIV in Uganda. The tool's modifications, including a simplified Likert-type scale and the inclusion of local healthcare terms, improved clarity and relevance. The STARx-Uganda can guide healthcare providers in improving the continuity of HIV care. Future research should evaluate the tool's impact on long-term health outcomes and expand its application in diverse settings.