Implementation of a Psychosocial Support Intervention for Adolescents on Antiretroviral Treatment: Challenges and Experiences from Ehlanzeni District, South Africa

Abstract

Adolescents living with HIV (ALHIV) need support from family, peers and health workers to remain on antiretroviral therapy and achieve and sustain viral suppression. This paper qualitatively explores the implementation of a psychosocial support intervention (PSS) in five primary health care facilities in the Ehlanzeni district, South Africa. Data were collected through key informant interviews and focus group discussions with ALHIV on ART. Data analysis employed inductive thematic analysis. Informed consent was obtained prior to all data collection. The PSS intervention facilitated full disclosure of HIV status to adolescents, supported treatment adherence through health education, peer support, health care provider- and client relations, and quick access to health service delivery. However, COVID-19 restrictions and regulations challenged the implementation of the intervention. The PSS intervention showed promise to support adolescent’s adherence and retention in care. We recommend innovative approaches to account for systemic disruptions, as evidenced by the COVID-19 pandemic.

Support provided by outreach team leaders to caregivers of HIV/AIDS orphans in the North-West Province of South Africa

“…This initiative was implemented in an adolescent-friendly and safe space in the clinics in the form of social clubs. Interestingly, the authors stated that the PSS intervention promoted treatment adherence through peer support, health education, and relationships between adolescents, caregivers, and healthcare providers [77]. Another signi cant nding reported by the same authors was that the PSS intervention expedited full disclosure of HIV status to adolescents was also expedited by PSS intervention.…”

“…Similarly, a qualitative study conducted in ve primary healthcare facilities in the SA revealed the effectiveness of a psychosocial support intervention (PSS) for adolescents on ART [77].…”

Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia

“…8 Poor treatment outcomes in adolescents are attributed to a myriad of factors, including poor treatment literacy and understanding of the benefits of ART adherence as well as a lack of motivation to comply with guidance on treatment regimens. 9 Other barriers for adolescents include forgetfulness, lack of social support, substance abuse, mental health issues (self-stigma, depression, anxiety), medication side effects, food insecurity, being orphaned, lack of transportation, reliance on adults, HIV status non-disclosure, health systems, and other broader structural challenges. 10 …”

“…Evidence suggests that peer support can be key to addressing behavioral issues, self-esteem, social skills, coping skills, cognitive and emotional behavioral issues, depression, anxiety symptoms, sexual and reproductive issues, substance abuse, and other psychosocial issues that may be related to the adolescent stage and living with HIV. 9 , 11 Examples of programs implemented in sub-Saharan African countries such as Tanzania, Mozambique, and Zimbabwe are the Resilient Empowered Adolescent and Young People Program and the Community Adolescent Treatment Supporter (CATS) programs, also known as Zvandiri, which have also been scaled up in other countries in recent years. 12 …”