Abstract:
Introduction Adolescents living with HIV (ALHIV) may
be vulnerable to widescale impacts of the COVID-19
pandemic and to health system responses which
impact HIV care. We assessed healthcare worker (HCW)
perspectives on impacts of the COVID-19 pandemic on
adolescent HIV care delivery and engagement in western
Kenya.
Methods We performed in-depth qualitative interviews
with HCW at 10 clinical sites in the Academic Model
Providing Access to Healthcare in Kenya, from January
to March, 2021. Semistructured interviews ascertained
pandemic-related impacts on adolescent HIV care delivery
and retention.
Results Interviews were conducted with 22 HCWs
from 10 clinics. HCWs observed adolescent financial
hardships, unmet basic needs and school dropouts during
the pandemic, with some adolescents relocating to rural
homes, to partners or to the street. Marked increases in
adolescent pregnancies and pregnancy complications
were described, as well as barriers to family planning and
antenatal care. Transportation challenges and restrictions
limited access to care and prompted provision of multi month refills, refills at local dispensaries or transfer to local
facilities. Adolescent-friendly services were compromised,
resulting in care challenges and disengagement from
care. Clinic capacities to respond to adolescent needs
were limited by funding cuts to multidisciplinary staff
and resources. HCW and youth peer mentors (YPMs)
demonstrated resilience, by adapting services, taking
on expanded roles and leveraging available resources to
support adolescent retention and access to care.
Conclusions ALHIV are uniquely vulnerable, and
adolescent-friendly services are essential to their treatment.
The combined effects of the pandemic, health system
changes and funding cuts compromised adolescent-friendly
care and limited capacity to respond to adolescent needs.
There is a need to reinforce adolescent-friendly services
within programmes and funding structures. Support for
expanded YPM roles may facilitate dedicated, scalable and
effective adolescent-friendly services, which are resilient
and sustainable in times of crisis.
