Background: Inadequate provision of accessible and acceptable HIV services has been cited as a barrier to engagement and retention in HIV care among adolescents. We assessed provision of adolescent services at HIV treatment facilities throughout Kenya.
Methods: We conducted a survey at 102 large (≥500 HIV-infected patients) facilities in Kenya randomly selected among clinics using electronic medical records. Interviews were conducted with healthcare providers between February-May 2017. Respondents provided information on provision of adolescent (ages 10-19 years) care including: adolescent-dedicated services, workforce training, HIV treatment practices, and reproductive health services.
Results: Facilities reported an average of 110 adolescents (Range: 4-1462) ever enrolled in care with an average of 62 (Range: 3-508) in active follow-up. Forty-four percent of clinics had dedicated pediatric and adolescent clinic staff. Fifty-seven percent saw adolescents only on specific adolescent days rather than integrated into days for adults (23%), children (15%) or combined adult/pediatric days (9%). Most (72%) clinics reported having received training in adolescent HIV service provision while 59%) reported receiving training in providing adolescent sexual and reproductive health services. Only 64% of clinics identified themselves as providing “adolescent friendly services.”
Most (81%) clinics offered peer support groups or teen clubs. Adolescents were most often given one month (51%) or three months (22%) of medication. Fifty-one clinics (50%) reported varying medication delivery based on school schedules and/or medication adherence. Almost all clinics (99%) allowed a proxy to pick up medication for adolescents. One-third (34%) required a parent or primary caregiver to be present when providing HIV care to adolescent minors (ages 10-17) while 47% listed specifications for when care could be provided in the absence of a caregiver, including adolescent maturity and disease severity. Median age for initiating transition from pediatric to adult care was 15 years (IQR: 12-18), and for planned completion of transition was 19 years (IQR: 18-20). Most clinics reported providing condoms (65%), family planning services (60%) and STI screening (67%) to adolescents.
Conclusions: This study demonstrates the implementation landscape for adolescent HIV services in Kenyan clinics. Continued training on adolescent HIV service provision can ensure uniformly high quality of care across regions and facilities.

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