Barriers to Retention in Care are Overcome by Adolescent-Friendly Services for Adolescents Living with HIV in South Africa: A Qualitative Analysis

Abstract

To assess facilitators and barriers to retention in care for adolescents living with HIV, we conducted in-depth, semi-structured interviews with adolescents ages 13 to 24 years who were living with HIV and being cared for in either an adolescent-friendly or standard governmentsupported clinic in KwaZulu-Natal, South Africa. We used inductive content analysis approach based on grounded theory derived from reviewing, coding, and interpreting data. We interviewed 28 adolescents living with HIV (16 in the adolescent clinic and 12 from the pediatric clinic) and 14 of their caregivers. Barriers to retention in care included having to attend clinic during school hours, fear of disclosure to others, social isolation, and conflict with clinical staff. Facilitators to retention in care seen in the adolescent-friendly services clinic included after school clinic hours, peer support, and connection to the clinical staff. Adolescent-friendly services are facilitators of HIV care and warrant prioritization in treatment programs.

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s National Antiretroviral Therapy Programme between 2012 and 2015

“…Our findings are consistent with other studies [41–43]. Adolescents and young adults have been shown to be at high risk of attrition due to several factors, which include lack of youth-friendly services, rigid scheduling not taking into account schooling, and unavailability of peer caregivers [44, 45]. Addressing these challenges can lead to improvement in the retention of adolescents and young adults on ART.…”

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s national antiretroviral therapy programme between 2012 and 2015

“…Our findings are consistent with other studies [49][50][51][52]. Adolescents and young adults have been shown to be at high risk of attrition due to several factors, which include lack of youth-friendly services, rigid scheduling not taking into account schooling, and unavailability of peer caregivers [53,54]. Addressing these challenges can lead to improvement in the retention of adolescents and young adults on ART.…”

Peer Support for Adolescents and Young People Living with HIV in sub-Saharan Africa: Emerging Insights and a Methodological Agenda

“…In support of these examples, some qualitative work has also underscored the benefits of peer support for AYPLHIV. Adolescents and young people have reported that peer support plays a significant role in improving adherence [22, 23], retention [24], and reducing viral load [23]. Both AYPLHIV and their caregivers have described support groups as safe spaces and an acceptable intervention [12, 25].…”