{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:42:18Z","timestamp":1785422538115,"version":"3.56.0"},"reference-count":53,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Adolescents living with human immunodeficiency virus (HIV) face disproportionately poor treatment outcomes because of a combination of psychosocial, structural and health systems challenges. Despite efforts to implement adolescent-friendly and differentiated service delivery models in Zambia, gaps remain in the organisation and delivery of care.\nAim:\u00a0This study aimed to explore how HIV services for adolescents are delivered and experienced by healthcare workers and programme managers in Lusaka District.\nSetting:\u00a0The study was conducted across six health facilities in Lusaka District, Zambia, representing different levels of the health system and providing HIV care to adolescents.\nMethods:\u00a0A descriptive qualitative design was employed. Thirty purposively selected participants (24 healthcare workers and six HIV programme managers) participated in individual in-depth interviews (IDIs) conducted between 20 February 2025 and 30 April 2025 using a semi-structured interview guide. Data were audio-recorded, transcribed verbatim and analysed using inductive content analysis.\nResults:\u00a0Inductive content analysis identified three themes: programmatic responses, highlighting strategic leadership, policy direction, adolescent-focused service delivery and workforce capacity building; implementation challenges, including inadequate infrastructure, health system limitations and individual-level barriers; and opportunities for improved programmatic response and service delivery, emphasising improvements in policy, health systems, infrastructure and service delivery.\nConclusion:\u00a0Although notable progress has been made in expanding adolescent HIV services in Lusaka, gaps in infrastructure, workforce and social support continue to affect programme effectiveness. Strengthening adolescent-responsive and sustainable care is essential to improve retention, viral suppression and Zambia\u2019s progress towards the Joint United Nations Programme on HIV\/AIDS (UNAIDS) 95-95-95 targets in the adolescent HIV cascade.\nContribution:\u00a0This study highlights barriers and opportunities in adolescent HIV programming in Lusaka, emphasising leadership, policy, service delivery and workforce capacity, while noting ongoing system and individual challenges. The findings can inform policy and practice to strengthen adolescent-responsive HIV care in Zambia and similar contexts.<\/jats:p>","DOI":"10.4102\/phcfm.v18i1.5189","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:26:43Z","timestamp":1771252003000},"update-policy":"https:\/\/doi.org\/10.4102\/safp.v67i1.6094","source":"Crossref","is-referenced-by-count":0,"title":["Health services and programmatic responses to improving adolescent HIV care in Lusaka, Zambia: A descriptive qualitative study"],"prefix":"10.4102","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3061-2241","authenticated-orcid":false,"given":"Kaala","family":"Moomba","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2993-6553","authenticated-orcid":false,"given":"Talitha","family":"Crowley","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1032-1847","authenticated-orcid":false,"given":"Brian","family":"van Wyk","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Munyayi FK, Van Wyk B. Experiences of support by unsuppressed adolescents living with HIV and their caregivers in Windhoek, Namibia: A qualitative study. Front Public Health. 2024;12:1380027. https:\/\/doi.org\/10.3389\/FPUBH.2024.1380027\/BIBTEX","DOI":"10.3389\/fpubh.2024.1380027"},{"key":"ref1","unstructured":"UNAIDS. The path that ends AIDS [homepage on the Internet]. 2023 [cited 2025 May 24]. Available from: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2023-unaids-global-aids-update-summary_en.pdf"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Mark D, Armstrong A, Andrade C, et al. HIV treatment and care services for adolescents: A situational analysis of 218 facilities in 23 sub-Saharan African countries. J Int AIDS Soc. 2017;20(Suppl 3):21591. https:\/\/doi.org\/10.7448\/IAS.20.4.21591","DOI":"10.7448\/IAS.20.4.21591"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Slogrove AL, Sohn AH. The global epidemiology of adolescents living with HIV: Time for more granular data to improve adolescent health outcomes. Curr Opin HIV AIDS. 2018;13(3):170. https:\/\/doi.org\/10.1097\/COH.0000000000000449","DOI":"10.1097\/COH.0000000000000449"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Bernays S, Jarrett P, Kranzer K, Ferrand RA. Children growing up with HIV infection: The responsibility of success. Lancet. 2014;383(9925):1355\u20131357. https:\/\/doi.org\/10.1016\/S0140-6736(13)62328-4","DOI":"10.1016\/S0140-6736(13)62328-4"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Mburu G, Ram M, Oxenham D, Haamujompa C, Iorpenda K, Ferguson L. Responding to adolescents living with HIV in Zambia: A social\u2013ecological approach. Child Youth Serv Rev. 2014;45(C):9\u201317. https:\/\/doi.org\/10.1016\/J.CHILDYOUTH.2014.03.033","DOI":"10.1016\/j.childyouth.2014.03.033"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Tih PM, Ayima CW, Boeyeo FN, Atanga PN, Eveline MK. High incidence and predictors of loss to follow-up among children and adolescents on life long antiretroviral therapy in the conflict-affected Northwest and Southwest Regions of Cameroon: A retrospective cohort study. Open AIDS J. 2023;17(1). https:\/\/doi.org\/10.2174\/18746136-V17-2305300-2022-20","DOI":"10.2174\/18746136-v17-2305300-2022-20"},{"key":"ref7","unstructured":"WHO. World Health Organization consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach. Geneva: World Health Organization, 2021; p. 1\u2013592."},{"key":"ref8","unstructured":"UNAIDS. Full report \u2013 In danger: UNAIDS Global AIDS update 2022 [homepage on the Internet]. UNAIDS; 2022 [cited 2025 Jun 02]. Available from: https:\/\/www.unaids.org\/en\/resources\/documents\/2022\/in-danger-global-aids-update"},{"key":"ref9","unstructured":"WHO. HIV and adolescents: Guidance for HIV testing and counselling and care for adolescents living with HIV [homepage on the Internet]. WHO Publications. World Health Organization, 2013 [cited 2024 Oct 23]; p. 100. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK217962\/"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Bekker LG, Johnson L, Wallace M, Hosek S. Building our youth for the future. J Int AIDS Soc. 2015;18(2):20027. https:\/\/doi.org\/10.7448\/IAS.18.2.20027","DOI":"10.7448\/IAS.18.2.20027"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Mutumba M, Bauermeister JA, Musiime V, et al. Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda: A qualitative study. AIDS Patient Care STDS. 2015;29(2):86\u201394. https:\/\/doi.org\/10.1089\/apc.2014.0222","DOI":"10.1089\/apc.2014.0222"},{"key":"ref12","unstructured":"ZSA, MOH I. Zambia demographic and health survey 2018 [homepage on the Internet]. Lusaka; 2018 [cited 2025 Jun 10]. Available from: https:\/\/dhsprogram.com\/pubs\/pdf\/FR361\/FR361.pdf"},{"key":"ref13","unstructured":"MOH. Adolescent HIV care and treatment: Healthcare worker\u2019s manual. Lusaka: Ministry of Health; 2020."},{"key":"ref14","unstructured":"MOH. Zambia consolidated guidelines for treatment and prevention of HIV infection. Lusaka: Ministry of Health; 2020."},{"key":"ref15","unstructured":"PEPFAR. PEPFAR 2023 Country and Regional Operational Plan (COP\/ROP) guidance for all PEPFAR-supported countries. Washington DC: United States Department of State; 2023."},{"key":"ref16","unstructured":"MOH. Differentiated Service Delivery (DSD) framework [homepage on the Internet]. Lusaka; 2022 [cited 2025 Apr 23]. Available from: https:\/\/www.differentiatedservicedelivery.org\/wp-content\/uploads\/2022-2026-Zambia-DSD-Implementation-Framework"},{"key":"ref17","unstructured":"MOH. Zambia consolidated guidelines for treatment and prevention of HIV infection [homepage on the Internet]. 2022 [cited 2025 Apr 23]. Available from: https:\/\/www.differentiatedservicedelivery.org\/wp-content\/uploads\/August-2022-Zambia-Consolidated-Guidelines.pdf"},{"key":"ref18","unstructured":"MOH. Zambia adolescent health strategic plan 2022\u20132026. Lusaka: Ministry of Health; 2022."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Moomba K, Crowley T, Van Wyk B. Mapping health policies for optimum service delivery to adolescents on HIV treatment in Zambia: A document review. BMC Health Serv Res. 2025;25(1):723. https:\/\/doi.org\/10.1186\/s12913-025-12868-6","DOI":"10.1186\/s12913-025-12868-6"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Miyingo C, Mpayenda T, Nyole R, et al. HIV treatment and care of adolescents: Perspectives of adolescents on community-based models in Northern Uganda. HIV\/AIDS. 2023;15:105\u2013114. https:\/\/doi.org\/10.2147\/HIV.S405393","DOI":"10.2147\/HIV.S405393"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Maskew M, Technau K, Davies MA, Vreeman R, Fox MP. Adolescent retention in HIV care within differentiated service-delivery models in sub-Saharan Africa. Lancet HIV. 2022;9(10):e726\u2013e734. https:\/\/doi.org\/10.1016\/S2352-3018(22)00137-0","DOI":"10.1016\/S2352-3018(22)00137-0"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Ford N, Newman M, Malumo S, Chitembo L, Gaffield ME. Integrating sexual and reproductive health services within HIV services: WHO guidance. Front Glob Women\u2019s Health. 2021;2:735281. https:\/\/doi.org\/10.3389\/fgwh.2021.735281","DOI":"10.3389\/fgwh.2021.735281"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Ng\u2018ambi K. Provision of adolescent-friendly sexual and reproductive health (SRH) services integrated into HIV treatment and care. J AIDS HIV Infect. 2016;2(2):203. https:\/\/doi.org\/10.15744\/2454-499x.2.203","DOI":"10.15744\/2454-499X.2.203"},{"key":"ref24","unstructured":"MoH. Ministry of Health National Youth Friendly Health Services strategy. Lusaka: Ministry of Health; 2015."},{"key":"ref25","unstructured":"CSO. Census of population and housing preliminary report [homepage on the Internet]. Republic of Zambia; 2022 [cited 2025 Jun 15]. Available from: www.zamstats.gov.zm"},{"key":"ref26","unstructured":"MOH. Evidence synthesis on adolescent health and HIV in Zambia [homepage on the Internet]. 2022 [cited 2025 May 10]. Available from: https:\/\/www.unicef.org\/zambia\/media\/3406\/file\/Adolescent Health and HIV Synthesis Report.pdf"},{"key":"ref27","unstructured":"Van Oirschot J, Ooms G, Bwana DE, Swai RG. Adolescent-friendly health services in Tanzania \u2013 Healthcare workers\u2019 perspectives on barriers and services offered [homepage on the Internet]. 2023 [cited 2025 Aug 05]; p. 1\u201320. Available from: https:\/\/haiweb.org\/wp-content\/uploads\/2023\/08\/HCW-Survey-Report_Tanzania_2023_FINAL-updated.pdf"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Vears DF, Gillam L, Vears D. Inductive content analysis: A guide for beginning qualitative researchers. FoHPE. 2022;23(1):111\u2013127. https:\/\/doi.org\/10.11157\/fohpe.v23i1.544","DOI":"10.11157\/fohpe.v23i1.544"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Kyng\u00e4s H. Inductive content analysis. In: Kyng\u00e4s H, Mikkonen K, K\u00e4\u00e4ri\u00e4inen M, editors. The application of content analysis in nursing science research. Cham: Springer Nature, 2020; p. 13\u201321.","DOI":"10.1007\/978-3-030-30199-6_2"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Kynga\u0308s H, Mikkonen K, Ka\u0308a\u0308ria\u0308inen M. The application of content analysis in nursing science research. Cham: Springer Nature; 2020.","DOI":"10.1007\/978-3-030-30199-6"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health. 2021;13(2):201\u2013216. https:\/\/doi.org\/10.1080\/2159676X.2019.1704846","DOI":"10.1080\/2159676X.2019.1704846"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Johnson JL, Adkins D, Chauvin S. A review of the quality indicators of rigor in qualitative research. Am J Pharm Educ. 2020;84(1): 7120. https:\/\/doi.org\/10.5688\/ajpe7120","DOI":"10.5688\/ajpe7120"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u2013357. https:\/\/doi.org\/10.1093\/intqhc\/mzm042","DOI":"10.1093\/intqhc\/mzm042"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Boyd MA, Fwoloshi S, Minchella PA, et al. A National HIV Clinical Mentorship Program: Enabling Zambia to accelerate towards the controlling the HIV epidemic. PLoS Glob Public Health. 2022;2(2):e0000074. https:\/\/doi.org\/10.21203\/rs.3.rs-151655\/v1","DOI":"10.1371\/journal.pgph.0000074"},{"key":"ref35","unstructured":"WHO. Age of consent: Legal review Zambia country report. Lusaka: World Health Organization; 2014."},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Mashamba L, Letswalo L, Mkhonto F, Ramalepa T. Barriers to the provision of youth-friendly services for adolescents living with HIV and AIDS. Int J Res Bus Soc Sci. 2024;13(9):177\u2013185. https:\/\/doi.org\/10.20525\/ijrbs.v13i9.3806","DOI":"10.20525\/ijrbs.v13i9.3806"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Cuadros DF, Huang Q, Mathenjwa T, Gareta D, Devi C, Musuka G. Unlocking the potential of telehealth in Africa for HIV: Opportunities, challenges, and pathways to equitable healthcare delivery. Front Digit Health. 2024;6:1278223. https:\/\/doi.org\/10.3389\/FDGTH.2024.1278223","DOI":"10.3389\/fdgth.2024.1278223"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Elendu C, Amaechi DC, Elendu TC, et al. Shaping sustainable paths for HIV\/AIDS funding: A review and reminder. Ann Med Surg. 2025;87(3):1415\u20131445. https:\/\/doi.org\/10.1097\/MS9.0000000000002976","DOI":"10.1097\/MS9.0000000000002976"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Genberg B, Wachira J, Kafu C, et al. Health system factors constrain HIV care providers in delivering high-quality care: Perceptions from a qualitative study of providers in Western Kenya. J Int Assoc Provid AIDS Care. 2019;18:2325958218823285. https:\/\/doi.org\/10.1177\/2325958218823285","DOI":"10.1177\/2325958218823285"},{"key":"ref40","unstructured":"UNICEF. Supply chains save lives: Unlocking access for children, their families and communities [homepage on the Internet]. 2023 [cited 2025 Jun 10]. Available from: https:\/\/www.unicef.org\/supply\/media\/20346\/file\/Supply-chains-save-lives.pdf"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Perger T, Davtyan M, Foster C, et al. Impact of HIV-related stigma on antiretroviral therapy adherence, engagement and retention in HIV care, and transition to adult HIV care in pediatric and young adult populations living with HIV: A literature review. AIDS Behav. 2024;29(2):497\u2013516. https:\/\/doi.org\/10.1007\/s10461-024-04534-5","DOI":"10.1007\/s10461-024-04534-5"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"McHenry MS, Nyandiko WM, Scanlon ML, et al. HIV stigma: Perspectives from Kenyan child caregivers and adolescents living with HIV. J Int Assoc Provid AIDS Care. 2017;16(3):215\u2013225. https:\/\/doi.org\/10.1177\/2325957416668995","DOI":"10.1177\/2325957416668995"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Oryokot B, Kazibwe A, Oluka AI, et al. \u2018Swallowing these drugs every day, you get tired\u2019: A mixed-methods study to identify barriers and facilitators to retention and HIV viral load suppression among the adolescents living with HIV in TASO Mbale and TASO Soroti centers of excellence. AIDS Res Ther. 2025;22(1):1\u201313. https:\/\/doi.org\/10.1186\/s12981-025-00719-7","DOI":"10.1186\/s12981-025-00719-7"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Onyango MA, Chergui H, Sabin LL, et al. School-level barriers of antiretroviral therapy adherence and interventions to overcome them among adolescents living with HIV in Western Kenya: A qualitative study. Open AIDS J. 2021;15(1):93\u2013107. https:\/\/doi.org\/10.2174\/1874613602115010093","DOI":"10.2174\/1874613602115010093"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Zanoni BC, Sibaya T, Cairns C, Haberer JE. Barriers to retention in care are overcome by adolescent-friendly services for adolescents living with HIV in South Africa: A qualitative analysis. AIDS Behav. 2019;23(4):957. https:\/\/doi.org\/10.1007\/s10461-018-2352-6","DOI":"10.1007\/s10461-018-2352-6"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Sabin LL, Nguyen VC, Harvey K, et al. Challenges to antiretroviral therapy adherence and coping strategies to overcome them: Qualitative investigations of adolescents living with HIV, their caregivers, and clinicians in Vietnam. Open AIDS J. 2020;14(1):114\u2013126. https:\/\/doi.org\/10.2174\/1874613602014010114","DOI":"10.2174\/1874613602014010114"},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Weaver KE, Miller SJ, Harrison S. Perceived adherence-related barriers for youth living with HIV in the Southern United States. Clin Pract Pediatr Psychol. 2025;13(2):171\u2013179. https:\/\/doi.org\/10.1177\/21694826251322194","DOI":"10.1177\/21694826251322194"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Toromo JJ, Apondi E, Nyandiko WM, et al. \u2018I have never talked to anyone to free my mind\u2019 \u2013 Challenges surrounding status disclosure to adolescents contribute to their disengagement from HIV care: A qualitative study in western Kenya. BMC Public Health. 2022;22(1):1\u201310. https:\/\/doi.org\/10.1186\/s12889-022-13519-9","DOI":"10.1186\/s12889-022-13519-9"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Buh A, Deonandan R, Gomes J, Krentel A, Oladimeji O, Yaya S. Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis. PLoS One. 2023;18(11):e0295046. https:\/\/doi.org\/10.1371\/journal.pone.0295046","DOI":"10.1371\/journal.pone.0295046"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Tarantino N, Lowery A, Brown LK. Adherence to HIV care and associated health functioning among youth living with HIV in sub-Saharan Africa. AIDS Rev. 2020;22(2):93. https:\/\/doi.org\/10.24875\/AIDSRev.20000101","DOI":"10.24875\/AIDSRev.20000101"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Pretorius L, Gibbs A, Crankshaw T, Willan S. Interventions targeting sexual and reproductive health and rights outcomes of young people living with HIV: A comprehensive review of current interventions from sub-Saharan Africa. Glob Health Action. 2015;8(1):28454. https:\/\/doi.org\/10.3402\/gha.v8.28454","DOI":"10.3402\/gha.v8.28454"},{"key":"ref52","doi-asserted-by":"crossref","unstructured":"Nabunya P, Samuel K, Ssewamala FM. The effect of family support on self-reported adherence to ART among adolescents perinatally infected with HIV in Uganda: A mediation analysis. J Adolesc. 2023;95(4):834. https:\/\/doi.org\/10.1002\/jad.12157","DOI":"10.1002\/jad.12157"}],"container-title":["African Journal of Primary Health Care &amp; Family Medicine"],"original-title":[],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:26:49Z","timestamp":1771252009000},"score":1,"resource":{"primary":{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/5189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/phcfm.v18i1.5189","relation":{},"ISSN":["2071-2928","2071-2936"],"issn-type":[{"value":"2071-2928","type":"print"},{"value":"2071-2936","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"article-number":"a5189"}}