{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:39:14Z","timestamp":1787585954633,"version":"build-2736575974"},"reference-count":68,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T00:00:00Z","timestamp":1648512000000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,2,25]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-055948","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T13:00:50Z","timestamp":1648645250000},"page":"e055948","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["\u2018We are not going anywhere\u2019: a qualitative study of Kenyan healthcare worker perspectives on adolescent HIV care engagement during the COVID-19 pandemic"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8390-5881","authenticated-orcid":false,"given":"Leslie A","family":"Enane","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya"},{"name":"Indiana University Center for Global Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith","family":"Apondi","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya"},{"name":"Moi Teaching and Referral Hospital, Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Liepmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith J","family":"Toromo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Omollo","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Bakari","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Scanlon","sequence":"additional","affiliation":[{"name":"Indiana University Center for Global Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Wools-Kaloustian","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya"},{"name":"Indiana University Center for Global Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA"},{"name":"Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel C","family":"Vreeman","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya"},{"name":"Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York City, New York, USA"},{"name":"Arnhold Institute for Global Health, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,3,30]]},"reference":[{"key":"2025120521414843000_12.3.e055948.1","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jadohealth.2020.05.021","article-title":"Addressing Health Inequities Exacerbated by COVID-19 Among Youth With HIV: Expanding Our Toolkit","volume":"67","author":"Armbruster","year":"2020","journal-title":"J Adolesc Health"},{"key":"2025120521414843000_12.3.e055948.2","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.2105\/AJPH.2020.305915","article-title":"From HIV to COVID-19: Focusing on and Engaging Adolescents and Young Adults During the Pandemic","volume":"110","author":"DeLong","year":"2020","journal-title":"Am J Public Health"},{"key":"2025120521414843000_12.3.e055948.3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s10461-020-03005-x","article-title":"The Psychosocial Effects of the COVID-19 Pandemic on Youth Living with HIV in Western Kenya","volume":"25","author":"Dyer","year":"2021","journal-title":"AIDS Behav"},{"key":"2025120521414843000_12.3.e055948.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60149-4"},{"key":"2025120521414843000_12.3.e055948.5","unstructured":"UNAIDS . 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