Kenyan adolescents with HIV facing ‘devastating’ effects of COVID-19

A survey of adolescents (ages 10-19) with HIV in Western Kenya suggests 40% have gone without food and one third have lost out on income or education. 

But the study of 334 teenagers found that most were still on antiretroviral treatment (ART), highlighting their resilience and the effectiveness of their HIV care programmes. 

The adolescents answered survey questions by phone between July 2020 and January 2021. Most (275) were still in HIV care, but 59 had left care in the past 12 months. Participants’ median age was 17 and there was an even split between boys and girls (data on trans and gender non-conforming adolescents was not reported). Adolescents who had left HIV care were more likely to be older, female, socially vulnerable, and have started ART at an older age.

More than 40% had experienced food insecurity, which means there were times when they did not have enough to eat. A further 4% did not have enough to eat most of the time.  

More than one third stopped all schoolwork during the pandemic. This was more common among adolescents who had left HIV care than those still enrolled (46% vs. 36%).  

Around 10% were working before COVID-19, but two-thirds had lost their job due to the pandemic. More than a third (36%) relied on someone else who had lost a job or income during the pandemic.  

Between 5 and 6% showed signs of depression or anxiety, which is lower than anticipated. 

Nearly all (99%) had a supply of ARVs where they were staying. But 4% said they had less than one week of medication left, and 5% had skipped doses because they were worried about running out of medication.  

More adolescents out of HIV care were experiencing difficulties refilling ARV prescriptions than those still in HIV care (6.8% vs. 0.7%). These difficulties were caused by a lack of transport, curfew or travel restrictions, fear of travelling, hospital entry restrictions and drug shortages. 

Only 4% of adolescents reported having problems taking ART. Some said the pandemic had directly caused these challenges. For example, changes in living situations meant some adolescents were now around family members who did not know they had HIV, so they felt uncomfortable taking ARVs in front of them. 

Despite these challenges, the proportion of participants not adhering to ART was fairly typical for this age group, with 6% missing at least one dose in the past 7 days and 19% taking a dose more than an hour late. Adolescents who had left HIV care experienced greater difficulties filling ART medications or adhering to ART than those still in care. 

Some adolescents even said their ART adherence had improved, or that they had restarted treatment during the pandemic. Some said COVID-19 had motivated them to stay healthy. Others felt more able to take ARVs because they were not in school, where HIV-related stigma made it difficult to take medication. Several said their HIV clinic had made various efforts to support their treatment at home, including increased phone calls or messages and use of peer mentors. These things may have also improved ART adherence. 

Around one in five (19%) said they were worried about staying healthy during the pandemic. One of the biggest fears among adolescents was that having HIV might mean they were more likely to get ill if they got COVID-19.  

The findings show the need to improve support for adolescents with HIV during times of crisis, particularly in relation to food and education. Using electronic data systems to track adolescent patients, providing multi-month ARV refills, using peer mentors, and providing remote care via mobile phone are all types of support that have proven to be effective in ensuring ART adherence continues.