‘We are not going anywhere’: a qualitative study of Kenyan healthcare worker perspectives on adolescent HIV care engagement during the COVID-19 pandemic

Abstract

IntroductionAdolescents 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.MethodsWe 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.ResultsInterviews 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.ConclusionsALHIV 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.

HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review

“…Eleven studies in total reported providing HIV treatment and care during COVID-19 remotely through telehealth services such as telephone and videoconferencing. Five of the studies were from the United States of America (USA) [ 50 , 52 , 59 , 60 , 68 ] and one each from Zambia [ 63 ], Myanmar [ 62 ], Philippines [ 65 ], Indonesia [ 56 ], Tanzania [ 51 ], and Kenya [ 54 ]. These studies reported that providers completed the required paperwork, including conducting needs assessments electronically, either through e-mail or over the phone, to minimise in-person contact with their clients.…”

“…Service providers utilised different delivery approaches to overcome barriers to clients accessing ART during the COVID-19 pandemic, ensuring people on ART stayed supplied with their medications. For example, HIV service providers delivered ART to community dispensaries, community health centres, community pharmacies, and other community-based organisations [ 54 , 57 , 61 , 65 , 66 ]. Several services utilised their existing network of community-based health workers to deliver ART [ 52 , 55 ].…”

“…In Botswana, 84% of HIV clients accepted the home delivery of ART through a courier service, which resulted in the delivery of 91% of successful ART refills [ 61 ]. Many service providers reported home deliveries in Asia (Indonesia, Laos, Nepal, India, and China) and Sub-Saharan Africa (Namibia, Nigeria, Uganda, Kenya, and Botswana) [ 54 , 57 , 58 , 61 , 64 – 67 , 69 ].…”

“…Thirteen studies reported on how HIV/AIDS organisations maintained access to ART during the pandemic by expanding their ART dispensing points. This included developing community ART dispensing strategies, setting up primary care outreach points where clients could collect their medications, decentralising ART distribution to dispensaries, dispensing through community-based organisations [ 52 , 58 , 61 , 64 , 65 , 67 ], and expanding or initiating multi-month dispensing [ 51 , 53 , 54 , 60 , 62 , 66 , 69 ]. For example, HIV service providers in Uganda utilised community drug distribution points to take ART closer to clients and facilitate access [ 69 ].…”

Perceptions of Global Health Engagements in Relation to the COVID-19 Pandemic Among Health Care Workers and Administrators in Western Kenya: Protocol for a Multistage Qualitative Study

“…This unprecedented shift has impacted local health care workers, health care administrators, and the health systems in which they work. Like in many other countries, health care workers in Kenya have experienced increased stressors, anxiety, insomnia, depression, and burnout [35][36][37]. Although occupational challenges are being increasingly well documented, far less is known about the potential new understandings health care workers and health care administrators are gaining as they make meaning of their work, the health care system, and the role of global health activities in relation to the COVID-19 pandemic in Kenya.…”