HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub‐Saharan African countries

Abstract

Introduction: In 2013, an estimated 2.1 million adolescents (age 10–19 years) were living with HIV globally. The extent to which health facilities provide appropriate treatment and care was unknown. To support understanding of service availability in 2014, Paediatric‐Adolescent Treatment Africa (PATA), a non‐governmental organisation (NGO) supporting a network of health facilities across sub‐Saharan Africa, undertook a facility‐level situational analysis of adolescent HIV treatment and care services in 23 countries.Methods: Two hundred and eighteen facilities, responsible for an estimated 80,072 HIV‐infected adolescents in care, were surveyed. Sixty per cent of the sample were from PATA's network, with the remaining gathered via local NGO partners and snowball sampling. Data were analysed using descriptive statistics and coding to describe central tendencies and identify themes.Results: Respondents represented three subregions: West and Central Africa (n = 59; 27%), East Africa (n = 77, 35%) and southern Africa (n = 82, 38%). Half (50%) of the facilities were in urban areas, 17% peri‐urban and 33% rural settings. Insufficient data disaggregation and outcomes monitoring were critical issues. A quarter of facilities did not have a working definition of adolescence. Facilities reported non‐adherence as their key challenge in adolescent service provision, but had insufficient protocols for determining and managing poor adherence and loss to follow‐up. Adherence counselling focused on implications of non‐adherence rather than its drivers. Facilities recommended peer support as an effective adherence and retention intervention, yet not all offered these services. Almost two‐thirds reported attending to adolescents with adults and/or children, and half had no transitioning protocols. Of those with transitioning protocols, 21% moved pregnant adolescents into adult services earlier than their peers. There was limited sexual and reproductive health integration, with 63% of facilities offering these services within their HIV programmes and 46% catering to the special needs of HIV‐infected pregnant adolescents.Conclusions: Results indicate that providers are challenged by adolescent adherence and reflect an insufficiently targeted approach for adolescents. Guidance on standard definitions for adherence, retention and counselling approaches is needed. Peer support may create an enabling environment and sensitize personnel. Service delivery gaps should be addressed, with standardized transition and quality counselling. Integrated, comprehensive sexual reproductive health services are needed, with support for pregnant adolescents.

An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE‐AIM Framework.

“…We observed that lack of training in transitioning ALHIV, lack of clear guidelines or tools to support transition, inadequate human resource and refusal of ALHIV to transition to adult care negatively in uenced successful transition. These ndings were consistent with other ndings that explored provider's perspective on ALHIV transition [25][26][27][28][29][30][31][32][33]. Studies from Uganda and South Africa [31,32] found that training, lack of clear guidelines or tools to support transition and overburdened SPs affected successful transition [28][29][30].…”

“…Also, all previous studies were from high income countries such as the USA and Canada with stronger health systems than Malawi. Only a few studies have been conducted in Africa , the majority of these have been qualitative focusing on exploring the perception of patients and providers with regard to barriers and facilitators of successful transition [25][26][27][28][29][30][31][32][33]. However, our ndings of poor implementation delity of HIV teen club transition protocol in most health facilities suggest that our ndings on low transition are valid.…”

Retention and adherence

“…Sustaining ART adherence is critical to achieve virological suppression, prevent drug resistance, halt disease progression, and prevent transmission [48,49,89]. Evidence suggests that AYALHIV fail to achieve and maintain adequate adherence.…”

Factors influencing access of HIV and sexual and reproductive health services among adolescent key populations in Kenya

“…Available evidence shows that MSM who disclose their orientation, through choice or necessity, report family rejection, public humiliation, harassment by authorities and ridicule by health-care workers (Ayehu et al 2016;Muthengi et al 2016). This population often face significant challenges in accessing HIV care and treatment (Mark et al 2017) due to stigma and discrimination from health providers (Godia et al 2013), and ignorance within health systems (Johnston et al 2017) about their sexual orientation (World Health Organization 2014). Inadequate healthcare providers' skills have been identified as a key barrier to provision of services to key populations (Baggaley et al 2015).…”