<p><strong>PURPOSE: </strong>Adolescent medicine is not a recognized specialty in most African countries and African healthcare providers receive little adolescent-specific training. We explored the association between training, self-reported competence, and clinical practice related to adolescent health in an African setting.</p>

<p><strong>METHODS: </strong>A total of 119 healthcare providers of various disciplines who work with adolescent patients in Francistown, Botswana were surveyed regarding their adolescent-specific training, self-reported competence, and counseling practices. Self-reported competence and practices related to counseling adolescents about sexual activity, alcohol and/or drug use, human immunodeficiency virus (HIV)-specific issues, and mental health were explored.</p>

<p><strong>RESULTS: </strong>In all, 50.4% of respondents had received HIV training with an adolescent-specific component. Fewer had received adolescent-specific training outside the context of HIV prevention and management. Respondents were significantly more likely to report higher competence for all items except for counseling adolescents about depression and anxiety if they had received any adolescent-specific training. Respondents who reported higher competence were significantly more likely to report more frequent counseling of their adolescent clients.</p>

<p><strong>CONCLUSIONS: </strong>Our study suggests that adolescent-focused training is important for ensuring that adolescents receive counseling when presenting for routine healthcare in our setting. The mental health needs of adolescents do not seem to be adequately addressed by current training.</p>

<p>OBJECTIVE: To determine the validity of the Pediatric Symptom Checklist (PSC), a brief measure of psychosocial health, for screening HIV+ Batswana children. METHOD: Setswana versions of the parent and child PSC were administered to 509 HIV+ Batswana children (age 8-16) and their parents/guardians. Test properties were evaluated and cut-off scores were derived using receiver operating characteristic curve analysis. Scores on the parent-completed PSC and the child-completed PSC-Y were compared to parental and clinic staff reports of concern about the child's psychosocial health and to scores on the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. RESULTS: The Setswana PSC has high internal consistency (Cronbach's alpha 0.87 for the parent-completed version). Comparing PSC scores to parental reports of concern and child-reported depression symptoms, a cut-off score of 20 on the PSC and PSC-Y maximised the sensitivity and specificity. CONCLUSIONS: The PSC performed well in Setswana-speaking children and is a promising screening tool for paediatric psychosocial problems in busy clinical settings. Screening with the PSC may allow for early detection and treatment of psychosocial problems. This is likely to be of particular value for HIV+ children for whom HIV treatment non-adherence may result from untreated psychosocial dysfunction.</p>

<p>Psychosocial dysfunction in older children and adolescents is common and may lead to nonadherence to HIV treatments. Poor adherence leads to HIV treatment failure and the development of resistant virus. In resource-limited settings where treatment options are typically limited to only one or two available lines of therapy, identification of individuals at highest risk of failure before failure occurs is of critical importance. Rapid screening tools for psychosocial dysfunction may allow for identification of those children and adolescents who are most likely to benefit from limited psychosocial support services targeted at preventing HIV treatment failure. The Pediatric Symptom Checklist (PSC) is used in high resource settings for rapid identification of at-risk youth. In 692 HIV-infected treated children (ages of 8-&lt; 17 years) in Botswana, having a high score on the PSC was associated with having virologic failure (OR 1.7, 95% CI: 1.1-2.6). The PSC may be a useful screening tool in pediatric HIV.</p>