This was by accommodating scheduling needs or transfer to an accessible site. While unstable living situations contributed to disengagement, having supportive caregivers and clinic-level flexibility supported re-engagement in care. So, from there is when transport has been an issue.” – Male, 19. It was near, but now that dad retired last year, he went to.
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“I was just staying here, so I was just coming on foot. So, I stayed for three to four months without taking the drugs.” – Female, 19. “When was with my friends, I did not want them to know that I am taking drugs. “I went to these family members that I have never gone to … It’s far from town, something like a rural area, so I found it hard because they never knew my status.” – Female, 20. Orphaned adolescents faced challenges navigating HIV care while also coping with parental loss, relying on new caregivers, changing households, or living on the street. Instability in adolescent living situations was a central factor in disengagement. Also recruited were 28 healthcare workers who included clinical officers, nurses, outreach workers, social workers and a psychologist. Thirty-four caregivers, including parents, uncles, aunts and grandparents, also participated in this study. Most participants (64%) were between 15-19 years and 67% had experienced the death of at least one parent. The investigators traced 10-19 year olds who had been enrolled at Moi Teaching and Referral Hospital or Kitale District Hospital in western Kenya and had missed their last appointment for 60 days or more.Ī total of 42 disengaged adolescents took part in the study, with the majority (67%) being female.
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Since adolescents experience significant transitions related to caregiver, peer and social relationships which impact their wellbeing, the current research investigated how family-level environments affect disengagement or support re-engagement in HIV care.
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This study, by Dr Courtney Myers of Indiana University, follows a previous report which found that trauma is a major underlying reason for adolescents disengaging from HIV care in Kenya. In Kenya, AIDS is the leading cause of illness and death among adolescents. And despite the scale-up of antiretroviral therapy, adolescents still have poorer treatment outcomes, including lower viral suppression rates poor adherence to medication higher rates of disengagement from care and high mortality compared to other age groups. Of the 1.7 million adolescents (ages 10–19) living with HIV globally, 89% live in sub-Saharan Africa. These challenges were compounded by poverty, stigma at the household level, and lack of caregiver capacity and skills to support adolescent HIV care. Adolescents living with HIV in Kenya – particularly those orphaned by the loss of one or both parents – experienced challenges when new caregivers or unstable living situations undermined HIV care engagement, according to a qualitative study recently published in the Journal of the International AIDS Society.