“Adolescents do not only require ARVs and adherence counseling”: A qualitative investigation of health care provider experiences with an HIV youth peer mentoring program in Ndola, Zambia

Abstract

Introduction Adolescents and young adults (AYAs) living with HIV face unique challenges and have poorer health outcomes than adults with HIV. Project YES! was a youth-led initiative to promote HIV self-management and reduce stigma among AYAs in four Ndola, Zambia clinics. Clinic health care providers (HCPs) were involved in multiple intervention aspects, including serving as expert resources during AYA and caregiver group meetings, facilitating resistance test-based AYA antiretroviral drug changes, meeting with participants referred through a safety protocol, and guiding a subset of participants’ physical transition from pediatric to adult clinic settings. This study aimed to understand HCP insights on facilitators and barriers to implementing Project YES! and scaling up a clinic-based, youth-focused program. Methods A trained interviewer conducted ten in-depth interviews with participating HCPs from November–December 2018 and analyzed data, identifying key themes. These themes were examined in terms of two implementation science outcomes–acceptability and feasibility–to inform scalability. Results HCPs found peer mentoring valuable for AYAs with HIV and the bimonthly caregiver meetings beneficial to AYA caregivers. HCPs voiced a desire for more involvement in specific processes related to patient clinical care, such as drug changes. HCPs’ experiences with the study safety protocol, including referrals for youth experiences of violence, shifted their views of AYAs and informed their understanding of key issues youth face. Considering this, many HCPs requested more resources to support AYAs’ varied needs. HCPs noted limited time and clinic space as implementation barriers but felt the program was valuable overall. Conclusions HCPs concluded youth peer mentoring was highly acceptable and feasible, supporting scale-up of youth-led interventions addressing the multi-faceted needs of AYAs living with HIV. Continued provider involvement in resistance test-based antiretroviral drug changes, considered in the context of health system and clinic policy, would enhance long-term success of the program at scale.

Lived experiences of adolescents living with human immuno- deficiency virus in Namibia

“…Lived experiences of adolescents living with human immuno-deficiency virus … (Ndinohokwe Mukerenge) 813 adolescents ranging from stigma, poor adherence to treatment; lack of knowledge on HIV; challenges understanding ART treatment; poor disease management skills; challenges with disclosure, and psycho-social issues, among others [4]- [6]. Conversely, in SSA, adolescents living with HIV have suboptimal adherence to antiretroviral therapy (ART) with consequent lower viral load suppression rates and higher mortality risk than other populations [7].…”

Lessons From Implementing Ask-Boost-Connect-Discuss, a Peer-Delivered Psychosocial Intervention for Young Mothers Living With HIV in Malawi, Tanzania, Uganda, and Zambia

“…Even where youth capacity-building and leadership have been effectively integrated into programming, layered with supervisory support, 35 it is crucial for peer supporters to be part of ongoing conversations that examine their working and social environments. In addition to reflecting the same “contained” sense of agency that we identified in data from ABCD, these findings also connect to broader debates about how peer-based interventions work (e.g., whether intervention content is a driving influence in effectiveness or whether interpersonal and social support carry more sway in influencing outcomes).…”

“Project YES! has given me a task to reach undetectable”: Qualitative findings from a peer mentoring program for youth living with HIV in Zambia

“…activities ended, and participants completed the endline assessment. Alongside the RCT, qualitative data were collected from youth participants, in addition to YPM, HCP, and caregivers of youth participants (findings from YPM and HCP are presented elsewhere [19,28]), to explore experiences with the Project YES! intervention.…”