ADOLESCENT HIV TESTING, COUNSELLING AND CARE
Implementation guidance for health providers and planners

Training

As discussed throughout this site, the role of health providers is vital in supporting adolescents to test for HIV, initiate and adhere to treatment, manage their HIV through continuous engagement with care services, and ultimately to live a long and healthy life. Adolescents may have few support structures at the very time of life when they are gaining independence from their families and exploring their emerging autonomy. As a result, health providers are often among the few people adolescents are willing to talk with about their health and other significant life issues that they face. Training strengthens the capacity of health providers to provide this important source of support, information and advice.

Training can help health providers to address the reluctance that some adolescents feel regarding HIV testing, counselling and care services. It can assist health providers in offering support to adolescents to make beneficial and ‘safe’ choices including prevention and disclosure. Negative experiences with health services – such as judgmental attitudes of providers or the perception of lack of privacy and/or confidentiality – can discourage adolescents from seeking the services they need and impede the development of good health-seeking behaviours in the future. In addition, because adolescents often lack the information and resources they need to stay healthy – particularly regarding HIV testing, treatment, prevention, care, nutrition and sexual and reproductive health – it is important that they feel confident that their health providers are knowledgeable about these issues. When adolescents talk about how to make services more acceptable and easier to access, they consistently mention the need for non-judgmental, well-informed and trusted health providers and services that respect their privacy and need for confidentiality.

Health providers also face many challenges as they address the needs of adolescents. More children living with HIV are surviving into adolescence, more adolescents need HIV testing, treatment and care and, at the same time, health services are often stretched by staff shortages. Many health care providers who are accustomed to providing care to children and adults must adjust their skills in response to the increasing needs of the adolescent cohort. Skills and competence requirements are complicated by the variety of settings where adolescent care services are provided, which may pose challenges to health workers who have not previously worked with adolescents or who have negative perceptions and beliefs about adolescents. In some clinical settings, there may be confusion about who has responsibility for providing adolescent services, which may result in their needs being inadequately addressed.

Health providers with limited knowledge about adolescent development often acknowledge their lack of understanding of adolescent patients. Some providers may be uncomfortable, uncertain or fearful about how to deal with the health and behavioural issues of adolescence, and sometimes this leads to adolescents feeling ignored or disregarded. Providing adolescent care can also mean interacting with parents or guardians who must also be helped to understand the importance of supporting their child’s emerging autonomy. Health providers can be critical facilitators of this shift in primary responsibility from parent to adolescent. See further discussion of this topic in the section on transition.

Health providers often do not have the experience or specific training needed to support adolescent patients. Adolescents think and react differently from children and from adults: they respond to different types of influences; they are experiencing rapid physical, psychological and emotional changes, and they are learning how to take more responsibility for themselves. Some health providers may not approve of the lifestyles or behaviours of adolescent patients, and some may feel overwhelmed by the array of physical and emotional issues that adolescent patients encounter. Adolescents can also find it difficult to manage the expectations – in terms of roles and behaviour – of their peers and adults in their lives. For all these reasons, there is a need to mobilize and train service providers at many levels to work with adolescents, supporting them to engage with and remain in care. In areas where there are workforce shortages, it is especially important that all providers receive adolescent-specific training, including lay counsellors and to support HIV-related task-shifting.

Communication is the foundation of all interactions between health providers and adolescent patients. As such, it is the most critical component of specialized training for adolescent service delivery. Health providers need to be willing to examine – and at times challenge and/or change – their personal attitudes and values, as well as their manner of communicating, in order to work sensitively and effectively with adolescents. Information materials and visual aids can also help providers to communicate better with adolescents living with HIV in relation to their treatment and care needs.

Training is an ongoing process. In isolation or as a one-time event, training rarely results in big changes in the quality of services or in provider attitudes. As a result, training needs to be part of a continuous process that includes a range of elements that may include formal training events, job aids, supportive supervision, training follow-up and mentorship. Adolescent feedback and/or suggestions about what is helpful are also useful. It is not necessary to create a separate cadre of HIV specialists to serve the needs of adolescents living with HIV. It is more important that training for working with adolescents is integrated into existing health training curricula and programmes, so that all health providers are able to respond to the needs of adolescents in a decentralized and integrated way.


WHO recommendation on Training

“Training of health-care workers can contribute to treatment adherence and improvement in retention in care of adolescents living with HIV...” Read more