Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
BMJ Open. 2022 Mar 30;12(3):e055948. doi: 10.1136/bmjopen-2021-055948.
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.
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.
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.
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.
感染艾滋病病毒的青少年（ALHIV）可能容易受到 COVID-19 大流行的广泛影响，以及影响艾滋病毒护理的卫生系统应对措施的影响。我们评估了肯尼亚医疗保健工作者（HCW）对 COVID-19 大流行对青少年艾滋病毒护理提供和参与的看法。
我们于 2021 年 1 月至 3 月在肯尼亚学术模式提供医疗保健服务的 10 个临床地点对 10 名 HCW 进行了深入的定性访谈。半结构化访谈确定了大流行对青少年艾滋病毒护理提供和保留的影响。
访谈对象为来自 10 个诊所的 22 名 HCW。HCW 观察到青少年在大流行期间经济困难、基本需求未得到满足和辍学，一些青少年搬到农村家庭、伴侣或街头。描述了青少年怀孕和妊娠并发症明显增加，以及计划生育和产前保健的障碍。交通挑战和限制限制了获得护理的机会，并促使提供了多份月的药物补充、在当地药房补充药物或转移到当地医疗机构。青少年友好服务受到影响，导致护理挑战和脱离护理。诊所应对青少年需求的能力因多学科工作人员和资源的资金削减而受到限制。HCW 和青年同伴导师（YPM）通过调整服务、承担扩展角色和利用现有资源来支持青少年保留和获得护理，表现出了韧性。
ALHIV 尤其脆弱，青少年友好服务对他们的治疗至关重要。大流行、卫生系统变化和资金削减的综合影响损害了青少年友好护理，并限制了应对青少年需求的能力。需要在方案和资金结构中加强青少年友好服务。支持扩大 YPM 的作用可能有助于提供专门、可扩展和有效的青少年友好服务，这些服务在危机时期具有弹性和可持续性。
