Supporting adolescents living with HIV within boarding schools in Kenya

Abstract

Adolescents and youth living with HIV (AYLHIV) are a uniquely vulnerable population facing challenges around adherence, disclosure of HIV status and stigma. Providing school-based support for AYLHIV offers an opportunity to optimize their health and wellbeing. The purpose of this study was to evaluate the feasibility of school-based supportive interventions for AYLHIV in Kenya. From 2016–2019, with funding from ViiV Healthcare, the Elizabeth Glaser Pediatric AIDS Foundation implemented the innovative Red Carpet Program (RCP) for AYLHIV in participating public healthcare facilities and boarding schools in Homa Bay and Turkana Counties in Kenya. In this analysis, we report the implementation of the school-based interventions for AYLHIV in schools, which included: a) capacity building for overall in-school HIV, stigma and sexual and reproductive health education; b) HIV care and treatment support; c) bi-directional linkages with healthcare facilities; and d) psychosocial support (PSS). Overall, 561 school staff and 476 school adolescent health advocates received training to facilitate supportive environments for AYLHIV and school-wide education on HIV, stigma, and sexual and reproductive health. All 87 boarding schools inter-linked to 66 regional healthcare facilities to support care and treatment of AYLHIV. Across all RCP schools, 546 AYLHIV had their HIV status disclosed to school staff and received supportive care within schools, including treatment literacy and adherence counselling, confidential storage and access to HIV medications. School-based interventions to optimize care and treatment support for AYLHIV are feasible and contribute to advancing sexual and reproductive health within schools.

Individual-, Interpersonal- and Institutional-Level Factors Associated with HIV Stigma Among Youth in Kenya

“…The reverse interpretation, that HIV stigma may result in AYWHIV dropping out of school suggests that the support for the AYWHIV to remain in school should include measures that mitigate the impact of HIV stigma in the school environment. Measures already tested in our setting include increasing HIV literacy among school staff, specific HIV treatment support measures in school like confidential treatment storage, linkages between schools and health facilities and psychosocial support [ 47 ].…”

“…Like other regions in Kenya, AYWHIV in Western Kenya go through the public school system, with a substantial proportion attending high schools with boarding facilities. The boarding schools especially pose a challenge for the learners in terms of storage of medication and keeping to required schedules for taking them medication and clinic attendance [ 47 ]. HIV care is largely provided through the donor-funded public health system, which in most places is not integrated with other health services.…”

Mobility and HIV care engagement: a research agenda

“…Relatedly, many studies find high rates of mobility among female sex workers, especially in West and Central Africa, but whether mobility is a risk factor or survival strategy for this vulnerable population is less clear [ 56 , 60 , 61 , 62 , 63 ]. Children and adolescents may move with their caregivers, and they may face additional mobility‐related challenges if attending boarding school [ 64 , 65 ]; this vulnerable population faces many treatment adherence challenges already, which may be compounded by mobility [ 66 , 67 ]. Finally, men who have sex with men (MSM) may experience high rates of mobility and unique challenges for engaging in care, and the few studies available suggest that mobility is associated with worse PrEP and ART outcomes among MSM.…”

Effect of Dolutegravir and Multimonth Dispensing on Viral Suppression Among Children With HIV

“…[60][61][62][63][64] Last, the school environment, especially being in a boarding school has been evaluated in previous studies and shown to negatively influence access to HIV care for children and their treatment outcomes. 65,66 The strength of this study was the utilization of a large data set of program data complemented by survey data from caregivers, which enabled a robust assessment of factors hypothesized to affect viral suppression to undetectable levels. We recognize some limitations in this study, including the reduced generalizability of our findings introduced by only including participants who had more than 1 VL in the study period.…”

“…60–64 Last, the school environment, especially being in a boarding school has been evaluated in previous studies and shown to negatively influence access to HIV care for children and their treatment outcomes. 65,66…”