Table 2 Potential programmatic interventions to support adolescents living with HIV

Domain 1: The Household

Facilitators: Supportive family members

Help adolescents identify one supportive individual in the household

Barriers: Absent parents, unstable housing, lack of discussion on HIV, socioeconomic stressors

Cultivate adult mentorship if parents absent, carry small supply of ART if household unstable to improve access to once daily ART, role playing on facilitating discussions on HIV and ART with the adolescent leading, provide socioeconomic support or incentives for the adolescent, cultivate family and household models of adherence support

Domain 2: The School

Facilitators: School content, supportive friends, supportive teachers

Identify positive school experiences as motivators for future and adherence, help adolescents identify supportive peers and adults, peer training programs

Barriers: Schools discussions on HIV, fear of inadvertent disclosure, missing school, stigma

Role play with adolescents on how to handle discussions of HIV in the classroom, train adolescents on how they can respond to potential disclosure situations, minimize school absences to attend clinics (see clinic section below), build self-esteem among adolescents living with HIV

Domain 3: The Larger Community

Facilitators: Supportive relationships, sports

Help adolescents identify potential supportive adults and peers, identify positive community institutions and events (i.e. sports, church) and incorporate these into adherence counseling

Barriers: Fear of inadvertent disclosure, missing “rites of passage”, stigma

Role play with adolescents on how to handle possible disclosure, identify strategies for participation in important rites of passage, build self-esteem among adolescents living with HIV

Domain 4: The Clinic

Facilitators: Supportive providers

Train providers in needs of adolescents and develop adolescent honest and friendly models of care (i.e. peer support, mentorship with adults who are on ART, etc.)

Facilitator: Clinic-based peer support group

Work with motivated charismatic adolescents to set up clinic-based peer support groups

Barriers: Clinic hours, lack of information about HIV and ART

Have flexible or evening clinic hours or dedicate one afternoon a week after school for adolescents, provide refresher training on HIV and ART using media/messaging that is adolescent friendly

Adolescents’ perceptions, experiences and sense of self

Facilitators: Internalized knowledge about HIV and ART, experiencing benefits from ART

Actively listen to adolescents express their understandings of HIV to develop individual training on HIV/ART, remind adolescents about positive benefits of being on ART, pair adolescents with adults on ART who have done well, peer support

Barriers: Side effects from ART

Screen for possible side effects and develop empowering management strategies for common problems