Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
London School of Hygiene & Tropical Medicine, London, UK.
J Int AIDS Soc. 2023 Jun;26(6):e26023. doi: 10.1002/jia2.26023.
Street-connected young people (SCY) experience structural and social barriers to engaging in the HIV prevention-care continuum. We sought to elicit recommendations for interventions that may improve SCY's engagement along the HIV prevention-care continuum from healthcare providers, policymakers, community members and SCY in Kenya.
This qualitative study was conducted in Uasin Gishu, Trans Nzoia, Bungoma, Nakuru and Kitale counties in Kenya between May 2017 and September 2018 to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY. This secondary analysis focuses on a subset of data interviews that investigated SCY's healthcare needs in relation to HIV prevention and care. We conducted 41 in-depth interviews and seven focus group discussions with 100 participants, of which 43 were SCY. In total, 48 participants were women and 52 men.
Our analysis resulted in four major themes corresponding to stages in the HIV prevention-care continuum for key populations. We identified the need for an array of strategies to engage SCY in HIV prevention and testing services that are patient-centred and responsive to the diversity of their circumstances. The use of pre-exposure prophylaxis was a biomedical prevention strategy that SCY and healthcare providers alike stressed the need to raise awareness around and access to for SCY. Several healthcare providers suggested peer-based approaches for engaging SCY throughout the continuum. However, SCY heavily debated the appropriateness of using peer-based methods. Structural interventions, such as the provision of food and housing, were suggested as strategies to improve antiretroviral therapy adherence.
This study identified contextually relevant interventions that should be adapted and piloted for use with SCY. Education and sensitization of SCY and healthcare providers alike were identified as possible strategies, along with affordable housing and anti-poverty strategies as cash transfers and provision of food. Peer-based interventions are a clear option but require SCY-specific adaptation to be implemented effectively.
街头流浪青年（SCY）在参与艾滋病毒预防-护理连续体方面面临着结构性和社会性障碍。我们试图从肯尼亚的医疗保健提供者、政策制定者、社区成员和 SCY 那里获得改善 SCY 参与艾滋病毒预防-护理连续体的干预措施建议。
本定性研究于 2017 年 5 月至 2018 年 9 月在肯尼亚乌辛古鲁、特南佐亚、邦戈马、纳库鲁和基塔莱县进行，旨在探讨和描述公众对 SCY 现象的看法，以及针对 SCY 现象提出的和现有的应对措施。这项二次分析侧重于数据访谈的一个子集，该访谈调查了 SCY 与艾滋病毒预防和护理相关的医疗保健需求。我们对 100 名参与者（其中 43 名为 SCY）进行了 41 次深入访谈和 7 次焦点小组讨论。共有 48 名参与者为女性，52 名参与者为男性。
我们的分析得出了四个与关键人群艾滋病毒预防-护理连续体各阶段相对应的主要主题。我们发现需要采取一系列策略，使 SCY 参与以患者为中心并能响应其各种情况的艾滋病毒预防和检测服务。使用暴露前预防是一种生物医学预防策略，SCY 和医疗保健提供者都强调需要提高对 SCY 的认识并提供获取途径。一些医疗保健提供者建议采用同伴为基础的方法在整个连续体中接触 SCY。然而，SCY 对使用同伴为基础的方法的适当性存在很大争议。有人建议采取结构性干预措施，如提供食物和住房，作为提高抗逆转录病毒疗法依从性的策略。
本研究确定了与具体情况相关的干预措施，这些措施应进行调整并进行试点，以用于 SCY。对 SCY 和医疗保健提供者进行教育和宣传被确定为可能的策略，同时还提出了提供住房和扶贫策略，如现金转移和提供食物。同伴为基础的干预措施是一个明确的选择，但需要对 SCY 进行具体调整才能有效实施。
