Implementation guidance for health providers and planners

Service Delivery and Retention

The needs of adolescents are different from those of adults and children, including for those living with HIV. To meet these unique needs, health services require a range of delivery and support approaches. Diversifying and adapting HIV service delivery options to effectively deliver appropriate services encourages adolescents to seek services and support, to initiate treatment when it is required, and to adhere to treatment and to stay engaged in care.

Services that apply adolescent-friendly principles can minimize or remove barriers to access and uptake of services; accommodate the particular needs of adolescents; and address the requirement for confidentiality, privacy and respect, as well as generate confidence and trust in their health providers.

Transition from child-oriented care to adult care is a critical process for adolescents and must be carefully planned and managed. It involves enrolling adolescents in services that are more appropriate for their developmental stage and health needs. Successful transition encourages the autonomy and self-management that adolescents will need to remain in care and adhere to lifelong treatment once they are adults.

Currently there are three main strategies to improve service delivery, recommended by WHO, based on current evidence and experience, which may, separately or in combination, reduce some of the barriers that discourage adolescents from seeking or remaining in care. Integration of services facilitates comprehensive care and allows adolescents to take care of many of their health needs at the same time, in the same place, simplifying their experience of the health care system. Decentralization of services brings ART and other treatment and support services and interventions closer to home. Decentralization may also support health equity by alleviating logistical and financial burdens for adolescents. Decentralization, if carefully planned and implemented, may provide safer, more discreet health care options particularly for adolescents who are members of key populations. Community-based approaches can support the health system, allowing for critical linkages and referrals between formal health services and community-based programmes and ensure that a multi-disciplinary approach is available, giving adolescents access to a range of medical, mental health, social and peer support services. Community-based approaches may be able to support adolescents to better adhere to treatment and be linked to and remain in care.

Retention in HIV care for adolescents living with HIV is critical as it will often lead to significantly better clinical management of HIV infection, and adherence to treatment, resulting in better quality of life and life expectancy, prevention of new HIV infections and decreased costs to health systems, individuals and their communities. When service delivery approaches make it easier for adolescents to access HIV services and address the challenges within services, adolescents are more likely to remain in care.

WHO recommendation on community-based approaches

Community-based approaches can improve treatment adherence and retention in care of adolescents living with HIV. Read more