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

ABSTRACT

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.

KEYWORDS:

• Adolescents
• antiretroviral therapy
• adolescent and youth-friendly services
• AYFS
• Kenya
• challenges
• HIV

Acknowledgments

The authors wish to express gratitude and acknowledge the contributions of Margaret Ndisha, Lazarus Rapando and team for data collection, Jacques Muthusi who supported in data cleaning, Nicolas Mutunga who facilitated introduction and entry to study sites, all the study site staff and the adolescents whose data were used in the study. This research was conducted as part of partial fulfilment for the award of Doctor of Philosophy (PhD) in Public Health at the School of Public Health, Jomo Kenyatta University of Agriculture and Technology in Juja, Kenya using personal funds.

Disclosure statement

No potential conflict of interest was reported by the authors.