Multi-level challenges and opportunities in providing antiretroviral treatment to adolescents in Kenya

• Published in: AIDS care 2021-03, Vol.33 (3), p.364-367
• Main Authors: Kimani, Daniel, Karanja, Simon, Ngure, Kenneth, Mwalili, Samuel
• Format: Article
• Language: English
• Subjects: Adolescent; adolescent and youth-friendly services; Adolescents; AIDS/HIV; Ambulatory Care Facilities; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Attitude of Health Personnel; AYFS; Best practice; Challenges; Cross-Sectional Studies; Data; Delivery of Health Care; Digital media; Female; Health Services Accessibility; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Infrastructure; Internet; Kenya; Kindness; Male; Privacy; Qualitative analysis; Quality of Health Care; Social media; Socioeconomic Factors; Support groups; Teenagers; Young Adult
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540121.2020.1717422

Adolescents have poor antiretroviral therapy (ART) outcomes due to multi-level factors. Adolescent and youth-friendly services (AYFS) have been implemented to address this. Adolescents on ART and HIV clinic managers were interviewed on their experiences with HIV care provision. Facility infrastructure was assessed using a standardized checklist. A 10-point criterion was set for AYFS. Descriptive analysis was used for quantitative data while qualitative data were thematically grouped and coded. Eighty-nine adolescents were interviewed including 46 males (52%) and 43 females (48%). The median age was 16.9 years (Interquartile range: 14.6-19.1 years). Some 36 (40.4%) adolescents raised the following facility-level challenges: long turnaround time, 12 (33.3%); clinic-school calendar conflict, 6 (16.7%); lack of digital media, 4 (11.1%); inadequate staff, 4 (11.1%) while another 10 (27.6%) cited lack of privacy, adolescent day and support groups. Clinic managers listed the availability of separate adolescents' days, adolescent-specific support groups, adolescent champion and use of social media as best practices. They listed several facility-related, society-related and adolescent-related challenges. Six facilities met six criteria of adolescent-friendliness (60%), one met five (50%) while two met four (40%). Although progress has been made in providing AYFS, key challenges remain that call for multi-sectoral interventions to ensure good ART outcomes.