“They Just Tell Me to Abstain:” Variable Access to and Uptake of Sexual and Reproductive Health Services Among Adolescents Living With HIV in Kenya

Abstract

Background: To improve holistic care for adolescents living with HIV (ALHIV), includingintegration of sexual and reproductive health services (SRHS), the Kenya Ministry ofHealth implemented an adolescent package of care (APOC). To inform optimized SRHservice delivery, we sought to understand the experiences with SRHS for ALHIV, theirprimary caregivers, and health care workers (HCWs) following APOC implementation.Methods: We completed a mixed methods evaluation to characterize SRHS providedand personal experiences with access and uptake using surveys conducted with facilitymanagers from 102 randomly selected large HIV treatment facilities throughout Kenya.Among a subset of 4 APOC-trained facilities in a high burden county, we conductedin-depth interviews (IDIs) with 40 ALHIV and 40 caregivers of ALHIV, and 4 focus groupdiscussions (FGDs) with HCWs. Qualitative data was analyzed using thematic analysis.Facility survey data was analyzed using descriptive statistics.Results: Of 102 surveyed facilities, only 56% reported training in APOC and 12%reported receiving additional adolescent-related SRHS training outside of APOC.Frequency of condomprovision to ALHIV varied, with 65%of facilities providing condomsdaily and 11% never providing condoms to ALHIV. Family planning (FP) was provided toALHIV daily in 60% of facilities, whereas 14% of facilities reported not providing any FPservices to ALHIV. Screening and treatment for STIs for adolescents were provided at allclinics, with 67% providing STI services daily. Three key themes emerged characterizingexperiences with adolescent SRHS access and uptake: (1) HCWs were the preferredsource for SRH information, (2) greater adolescent autonomy was a facilitator of SRH discussions with HCWs, and (3) ALHIV had variable access to and limited uptake of SRHSwithin APOC-trained health facilities. The primary SRHS reported available to ALHIV wereabstinence and condom use education. There was variable access to FP, condoms,pregnancy and STI testing, and partner services. Adolescents reported limited utilizationof SRHS beyond education.Conclusions: Our results indicate a gap in SRHS offered within APOC trained facilitiesand highlight the importance of adolescent autonomy when providing SRHS and furtherHCW training to improve SRHS integration within HIV care for ALHIV.