Project Details

Engaging adolescents to strengthen retention in HIV care in Eldoret, Kenya

Leslie Enane, MD

Summary

BACKGROUND: High mortality among adolescents with HIV reflects delays in diagnosis and management challenges that are particularly acute during the adolescent developmental stage. Adolescents are at risk for loss to follow-up from HIV care, which contributes to virologic failure and mortality in this age group. GAP: There are limited data regarding adolescent-specific barriers and facilitators to retention in HIV care, and regarding adolescent-centered interventions to improve retention. HYPOTHESES: We hypothesized that barriers to retention include developmental, familial, societal, and programmatic factors, while facilitators support adolescent needs and autonomy. We also hypothesized that engagement with adolescents will advance the development of highly relevant adolescent-centered interventions that directly address key barriers to adolescent retention in HIV care. METHODS: This is a qualitative study conducted within the Academic Model Providing Access to Healthcare (AMPATH), a large HIV treatment program in western Kenya. The study is comprised of 1) key informant interviews with youth peer mentors, exploring key barriers and facilitators to retention in HIV care experienced by adolescents; and 2) focus group discussions with peer mentors and adolescents engaged in HIV care, to consider potential programmatic interventions to improve adolescent retention and their implementation. RESULTS: The most central barriers to ALHIV retention included stigma, isolation, mental health issues and trauma. Stigma experienced at school or among peers was particularly difficult to navigate. Key facilitators enabled ALHIV to overcome stigma and isolation; through peer support, adolescent-friendly clinic services, and attending clinic in a space that is not only for HIV care. Areas of intervention to support retention include: expanding peer support and adolescent-friendly services, partnering with educators to address school-based stigma, and financial interventions, such as job training or microloans. IMPACT: Identified barriers and facilitators to adolescent retention will directly inform research and clinical practice in Kenya and in similar settings. Rich qualitative data around specific interventions and their implementation will facilitate the design of key interventions to improve adolescent retention in HIV care. Website Link: http://pediatrics.iu.edu/infectious-disease/our-team/faculty/leslie-enane-md/

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