Implementation guidance for health providers and planners

Retention in care

Adolescents living with HIV may need additional support to remain engaged in care. Retention, in both pre-ART and ART care, is critical for timely initiation of ART, monitoring for drug toxicity and resistance, adherence to ARVs and successful viral suppression. Health planners and providers need to think about the reasons why adolescents become disengaged from care and adapt service delivery accordingly.

The importance of retaining adolescents in care goes beyond solely treatment. Services that address the broad range of adolescents' physical, emotional, reproductive and social needs aid retention in HIV care and ultimately reduce morbidity, improve quality of life and life expectancy, prevent new HIV infections and reduce costs to the health system and the adolescents themselves. Multiple social, individual and structural factors, including aspects of the health system, influence an adolescent's retention in HIV care. Adolescents are in a rapidly evolving stage of their life (i.e. mental, physical and social development) and therefore may face unique retention challenges requiring additional support.

The monitoring of adolescents' engagement in care and treatment is fundamental for health providers and planners to identify and respond to key challenges in retention of adolescents in HIV care. Monitoring through routine collection of age-disaggregated data (e.g. clinic attendance, biological markers of treatment responses) promotes the establishment of practical mechanisms for patient follow-up, enables identification of adolescents who are not engaged in care, and develops strategies for re-engagement. Additionally, understanding and exploring the reasons for disengagement, including health systems challenges, allows for identification of gaps in services and the requirement for service changes, as well as the implementation of service delivery strategies, as highlighted in previous sections.