Uptake of prevention with positives services among HIV positive adolescents attending comprehensive care centres in Kakamega County, Kenya

Abstract

Background: Adolescents are vulnerable to HIV infection through engaging in behaviors associated with increased risk of HIV transmission. Prevention With Positives (PWP) Services are measures employed to minimize the risk of HIV transmission. Kenya is among the top six countries globally with a high burden of Adolescents Living with HIV (ALHIV). There is minimal data on the level of engagement of these adolescents with these PWP services. Objective: To evaluate the uptake of PWP services among HIV positive adolescents attending Comprehensive Care Centres (CCCs) in Kakamega County. Methods: A mixed methods, hospital based, cross-sectional study was conducted in seven CCCs within Kakamega County between February and December 2016. A structured questionnaire was used to collect data on socio-demographic characteristics, knowledge and uptake of PWP services among ALHIV. Focused group discussions (FGDs) for adolescents and key informant interviews (KII) for health care providers were conducted to explore factors that influenced uptake of these services. Descriptive statistics and frequency listings were used for continuous and categorical variables respectively. Fisher‟s exact and Pearson‟s Chi square tests were used to test for associations among socio-demographic characteristics and uptake of these services. Multivariate logistic regression was done to determine independent variables. Qualitative data was thematically analyzed. Results: The PWP services were offered in all the facilities. Of the 423 adolescents recruited, 218(51.5%) were females and 276(65.2%) were orphans and 127(30%) had secondary level of education. About 244(51.5%) reported Knowledge of PWP services. Engagement in risky behaviors was reported by 122(28.8%) with 70(16%) reporting sexual experience, of which 42/70(60%) had multiple sexual partners. Mean age at sexual debut was 13.4 years (range 7-19 years). Uptake of the PWP services was low. Condom use was by 30/70(42.9%) while contraceptives use was by 18/70(11.5%). Screening for sexually transmitted infections was at 24/70(34.3%). Disclosure of HIV status to sexual partners was at 16/42(38.1%) among the sexually experienced adolescents as 18/70(25.7%) did not know their own HIV status at sexual debut. Only 12/70(17%) knew their partners‟ HIV status. Higher education level was associated with increased likelihood of disclosure to sexual partner (AOR=2.74,CI=1.41-5.31, p value=0.003). Knowledge of own status was associated with higher condom use (AOR=19.3,CI 2.94-127.5, p value=0.014) while older age was associated with greater use of contraceptives (AOR=1.93, CI 1.02-3.67, p value =0.04). During FGDs, adolescents reported fear of rejection by partner, lack of privacy in accessing condoms and family planning (FP) commodities from health facilities and poor staff-adolescent relationship as challenges to the uptake of PWP services. Presence of peer counselors enhanced uptake. KII revealed lack of parental/guardian support and staff shortage hindered uptake. CONCLUSION: All the facilities offered the PWP services but their uptake was low. Increase in age, level of education and presence of peer counsellors increased their uptake. Poor staff-adolescent relationship and lack of privacy in accessing condoms and FP commodities hindered their uptake. Recommendation: Efforts should be made to enhance uptake of these services by improving staff-adolescent relationship and enhancing adolescents‟ privacy in accessing these commodities.