Health and social outcomes of HIV‐vulnerable and HIV‐positive pregnant and post‐partum adolescents and infants enrolled in a home visiting team programme in Kenya. Issue 6 (25th March 2021) - Levy, Marcy
Abstract: Objectives: HIV‐positive and HIV‐vulnerable pregnant adolescent girls and adolescent mothers face significant barriers and vulnerabilities. Infants born to adolescent mothers are also more likely to die and be exposed to life‐threatening conditions. This paper presents findings from an evaluation of a programme that used a home visitation model and offered a case‐management, team‐focused approach to increase family and community supportiveness to enhance health and social service uptake among pregnant adolescent girls and adolescent mothers in Kenya. Methods: The study used a quasi‐experimental design with before and after comparisons among a non‐randomised population to examine the effectiveness of bi‐monthly household visits to 384 enrolled pregnant adolescent girls, adolescent mothers (ages 10–19) and their infants (0–24 months) between March 2018 and February 2019 in three counties in Kenya. Results: During the programme, household support increased from 57% to 85%, while 100% of eligible participants were on ART and virally suppressed (total of 20 adolescents). Nearly all pregnant adolescent girls (94%) delivered under skilled care vs. 78% of those who were post‐partum at the time of enrolment ( P < 0.001); 100% of infants (total of 17 infants) had an up‐to‐date PCR test with no seroconversions. Uptake of modern family planning increased from 39% at baseline to 64% at end line ( P < 0.001). The referral rate declined from 84% to 78% from baseline to end line with low uptake of referrals for mental health services (17.3%). Conclusions: A team‐focused approach of home visits to HIV‐vulnerable and HIV‐positive pregnant and post‐partum adolescent girls and their infants combined with efforts to reduce stigma and increase supportiveness of households and the community can help address critical socio‐cultural and behavioural barriers to accessing and using health and social services.