A Pilot Study of “Peer Navigators” to Promote Uptake of HIV Testing, Care and Treatment Among Street-Connected Children and Youth in Eldoret, Kenya

Abstract

Research suggests a burden of HIV among street-connected youth (SCY) in Kenya. We piloted the use of peer navigators (PNs), individuals of mixed HIV serostatus and with direct experience of being street-connected, to link SCY to HIV testing and care. From January 2015 to October 2017, PNs engaged 781 SCY (585 male, 196 female), median age 16 (IQR 13–20). At initial encounter, 52 (6.6%) were known HIV-positive and 647 (88.8%) agreed to HIV testing. Overall, 63/781 (8.1%) SCY engaged in this program were HIV-positive; 4.6% males and 18.4% females (p < 0.001). Of those HIV-positive, 48 (82.8%) initiated ART. As of October 2017, 35 (60.3%) of the HIV-positive SCY were alive and in care. The pilot suggests that PNs were successful in promoting HIV testing, linkage to care and ART initiation. More research is needed to evaluate how to improve ART adherence, viral suppression and retention in care in this population.

HIV prevalence in young people and children living on the streets, Kenya

“…some local business leaders). We visited locations important to the street-connected youth under the guidance of existing peer navigators, 26 a specialized social worker, and both male and female street-connected youth community leaders. The locations around Eldoret at which participants congregate and shelter include peri-urban settlements, waste disposal sites and other locations either identified by the community leaders or known to the research team (e.g.…”

“…Participants were introduced to the peer navigators, whose job was to increase the uptake of both HIV testing and of care and treatment if positive, and the uptake of other health services as needed (e.g. psychological counselling) 26 . To protect the privacy and confidentiality of participants, we encouraged them to speak with the peer navigators if they had received an HIV-positive diagnosis, either previously or through our survey, and wanted help to access care.…”

Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya

“…In Kenya, street-connected young people (SCY), for whom the streets play a central role in their everyday lives and social identities (Office of the United Nations High Commissioner for Human Rights 2017), engage in sexual practices that increase their exposure to HIV (Kaime- Atterhög et al 2007;Embleton et al 2015Embleton et al , 2016Wachira et al 2015Wachira et al , 2016. In Eldoret, Kenya, SCY have a STI and HIV prevalence that exceeds that of other young people in Kenya (Winston et al 2015;Shah et al 2018;Braitstein et al 2019). Street-connected young women aged 15-24 have an HIV prevalence almost four times higher than young women nationally (11% vs. 3.0%) (NASCOP 2014;Braitstein et al 2019) and frequently die due to AIDS (Embleton et al 2018).…”

Improving livelihoods and gender equitable attitudes of street‐connected young people in Eldoret, Kenya: Results from a pilot evidence‐based intervention

“…Street-connected young people (SCY) in Kenya, for whom the streets play a central role in their everyday lives and social identities (Office of the United Nations High Commissioner for Human Rights, 2017), may be particularly vulnerable to acquiring HIV due to structural factors including: being precariously housed; abject poverty; gender inequities; barriers to education and accessing healthcare; economic marginalisation and an absence of sound policies and programmes for SCY (Coren et al, 2016;Sorber et al, 2014;Woan, Lin, & Auerswald, 2013). It is likely that these structural drivers are influencing SCY's engagement in harmful sexual practices (Embleton, Wachira, et al, 2016;Wachira et al, 2015), resulting in their elevated HIV prevalence (Braitstein et al, 2019;Goldblatt et al, 2015;Shah et al, 2018;Winston et al, 2015) and impacting their ability to implement HIV prevention practices.…”