A qualitative evaluation of stakeholder perspectives on the implementation of HIV services within adolescent and youth-friendly services for the youth in Nampula, Mozambique.

Background: Despite the well-documented challenges affecting HIV treatment for adolescents and young adults living with HIV (AYAHIV) in low- and middle-income countries, the implementation of recommended Adolescent and Youth-Friendly Services (AYFS) remains limited. In this qualitative study, we explored stakeholder perspectives on the implementation of HIV services for AYAHIV within AYFS in Nampula, Mozambique. This study forms part of a broader investigation on improving HIV care among adolescents and young adults living with HIV (AYAHIV) in Mozambique.

Methods: Using a purposive sampling strategy in an exploratory qualitative research study, we conducted semi-structured in-depth interviews between September and December 2021 with stakeholders, including healthcare workers (HCWs) delivering HIV services and key informants managing HIV services for youth on ART in 12 health facilities participating in the CombinADO study. The interviews were analyzed using thematic analysis.

Results: Participants included 59 stakeholders (44% HCWs and 56% KIs), the majority of whom were female (71%). The findings suggested variations in stakeholder perspectives on HIV service delivery, indicating disparities in service quality across different health facilities. While positive assessments prevail, notable barriers include inadequate staff training, staff shortages, limited privacy, absence of caregiver support, insufficient HIV literacy among AYAHIV and caregivers, and access constraints. Facilitators include patient-provider relationships, collaborative care, well-trained HCWs, support groups, effective dissemination of HIV awareness information, one-stop shops, and privacy.

Conclusions: Stakeholders shared positive perceptions and experiences concerning the delivery of HIV services to AYAHIVs within the current AYFS framework in Nampula. However, they also identified barriers-such as limited staff capacity, insufficient training, and lack of private spaces-that hinder the effectiveness of these services in addressing challenges related to retention, ART adherence, and HIV stigma among AYAHIVs. Addressing these barriers is essential to optimize HIV service delivery and improving outcomes for adolescents and young adults. Notably, findings from this study informed the refinement of the CombinADO intervention, which integrated enhanced HCW training, infrastructure strengthening, and peer-led support to better respond to AYAHIV needs within AYFS.

Trial registration number: ClinicalTrials.govNCT04930367. Registered on 18th June 2021.