Engaging adolescents to strengthen retention in HIV care in Eldoret, Kenya
Leslie Enane, MD
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.
Enane, Leslie A., Edith Apondi, Judith Toromo, Christopher Bosma, Antony Ngeresa, Winstone Nyandiko, and Rachel C. Vreeman. "“A problem shared is half solved”–a qualitative assessment of barriers and facilitators to adolescent retention in HIV care in western Kenya." AIDS care (2019): 1-9.
Enane LA, Eby J, Arscott-Mills T, Argabright S, Caiphus C, Kgwaadira B, Steenhoff AP, Lowenthal ED. ‘If you don’t address the challenges, they end up lost’ – TB and TB/HIV care for adolescents and young adults. Int J Tuberc Lung Dis. Accepted.
Enane, Leslie A., Elizabeth D. Lowenthal, Tonya Arscott-Mills, Jessica Eby, Cynthia Caiphus, Botshelo Kgwaadira, Susan E. Coffin, and Andrew P. Steenhoff. "Investigating Outcomes of Adolescents and Young Adults (10–24 Years of Age) Lost to Follow-up from Tuberculosis Treatment in Gaborone, Botswana." The Pediatric Infectious Disease Journal 38, no. 10 (2019): e271-e274.
Enane LA, Davies MA, Leroy V, Edmonds A, Apondi E, Adedimeji A, Vreeman RC. Traversing the cascade: urgent research priorities for implementing the “treat all” strategy for children and adolescents living with HIV in sub-Saharan Africa. Journal of Virus Eradication 2018. Accepted.
Enane, Leslie A., Keboletse Mokete, Dipesalema Joel, Rahul Daimari, Ontibile Tshume, Gabriel Anabwani, Loeto Mazhani, Andrew P. Steenhoff, and Elizabeth D. Lowenthal. "“We did not know what was wrong”—Barriers along the care cascade among hospitalized adolescents with HIV in Gaborone, Botswana." PloS one 13, no. 4 (2018): e0195372.
Enane, Leslie A., Rachel C. Vreeman, and Caroline Foster. "Retention and adherence: global challenges for the long-term care of adolescents and young adults living with HIV." Current Opinion in HIV and AIDS 13, no. 3 (2018): 212-219.