International Mentored Scientist Award

Exploring HIV care of highly mobile HIV-positive youth living in Kenya and Uganda: qualitative study to identify gaps in the HIV care cascade and evaluate feasible intervention options

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In sub-Saharan Africa (SSA) sub-optimal care engagement among youth living with HIV (YLWH) aged 15 – 24 years presents a challenge for the control of the HIV epidemic. Mobility is a chief contributor to the lags in the last two 90 of the 90-90-90 UNAIDS target in SSA- home to the largest intra-continental movement of people, largest youth population, and the highest burden of HIV/AIDS. The majority of YLWH in SSA access care within systems largely designed for adult and stable populations; service provision fails to meet their unique needs, leading to lapses in care and non-adherence. Further, the absence of in-depth quantitative and qualitative data on the mobility and HIV care access patterns of YLWH, makes it difficult to design scalable interventions that are designed informed by complex care decisions, inextricably tied with mobility. While many have explored care lapses among YLWH, very few have done so among mobile YLWH, informed by in-depth longitudinal mobility data. The proposed study builds the Mobility in SEARCH (R-01) and will take place from June 2019 to July 2020. The study endeavors to (1) explore HIV care barriers and facilitators as well as strategies of managing HIV care within care systems, and (2) understand preferences for care and intervention options, through in-depth interviews and participatory hierarchical sorting exercises with highly mobile YLWH. Participants will be selected on the basis of a theoretical sampling framework informed by longitudinal and novel measures of mobility collected during the first four years of the parent R-01. Translated interview transcripts will be collaboratively coded and analyzed using constructivist grounded-theoretical approaches by experienced qualitative researchers. Understanding the care patterns of highly mobile YLWH, and engaging them in a participatory process to evaluate HIV care models and interventions, will contribute towards the development of differentiated care models tailored for mobile YLWH.