Enhancing engagement in HIV care among adolescents and young adults: A focus on phone-based navigation and relationship building to address barriers in HIV care

• DOI: 10.1371/journal.pgph.0002830
• Publication Date: 2025-01-09T18:45:34Z
• Authors: Harriet Fridah Ad...; Chanda Mwamba; Jayne Lewis-Kulzer; Sarah Iguna; Gladys Moraa Ontuga; Dorothy Imbuka Ma...; Everlyne Nyandieka; James Nyanga; Isaya Opondo; Joseph Osoro; Lina Montoya; Edwin Nyagesoa; Norton Sang; Eliud Akama; Elizabeth Bukusi; Lisa Abuogi; Elvin Geng; Zachary Arochi Kwena
• Keywords: ICTS (Institute of Clinical and Translational Sciences); Medicine and Health Sciences; 150; 610; Public aspects of medicine; RA1-1270; Research Article

Structural, psychological, and clinical barriers to HIV care engagement among adolescents and young adults living with HIV (AYAH) persist globally despite gains in HIV epidemic control. Phone-based peer navigation may provide critical peer support, increase delivery flexibility, and require fewer resources. Prior studies show that phone-based navigation and automated text messaging interventions improve HIV care engagement, adherence, and retention among AYAH. However, little is known about AYAH experiences utilizing electronic phone-based peer navigation and automated text messaging (E-NAV). We assessed the experiences of AYAH receiving phone-based peer navigation to address barriers to HIV care engagement and viral suppression. We purposefully selected participants randomized to E-NAV within the Adapt for Adolescents in Kisumu, Kenya, and conducted 20 in-depth interviews. Interviews were conducted by a trained qualitative researcher between October and December 2021 and explored topics such as health-seeking and care experiences, E-NAV acceptability and benefits, and the client-navigator relationship. The interviews were audio-recorded and transcribed. We then applied inductive and deductive coding, followed by thematic analysis. Overall, participants found E-NAV acceptable in regard to content and frequency–particularly the opportunity to select a preferred time for calls/text messages, including evenings and weekends. They found the tone of navigator calls and messages friendly, supporting relationship building. Further, AYAH-navigator relationships were described as fraternal, client-focused, and confidential, which supported a personal connection and trust. Reported E-NAV benefits included adherence and appointment reminders, increased knowledge about HIV care, and strategies to address HIV stigma. Electronic navigation is a promising method for youth peer navigation because it optimizes reach (both in time and space) for youth that have severe constraints on both while preserving the ability to create a rapport and a relationship with patients.