HIV programme to enhance adherence to art among older adolescents and younger adults living with HIV in Africa

The global concern of suboptimal viral load suppression (VLS) rates falling below the 95% target among older adolescents living with HIV (OALHIV) and young adults living with HIV (YALHIV) remains a critical concern, particularly in Namibia and other regions of Africa. These low suppression rates are influenced by multiple factors, including the unique developmental circumstances of this age group, limitations within healthcare systems, and broader socio-environmental determinants. The absence of targeted HIV programmes that address the specific needs of OALHIV and YALHIV highlights a significant gap in care. In response, this study aimed to develop an HIV programme specifically designed to enhance adherence and improve VLS outcomes among this population. The study employed an explanatory sequential mixed-methods approach, conducted in four distinct phases. Participants included OALHIV, YALHIV, HCPs, and HIV, all selected through purposive sampling. Findings from the initial phases were synthesised into key elements, which informed the development of an HIV programme guided by Dickoff's Practice-Oriented Theory and validated following the online Delphi technique. Data was collected through a semi-structured online questionnaire and analysed using IBM SPSS version 28. Consensus was achieved with 15 HIV experts. The study identified various individual, health system, and community-level barriers negatively impacting OALHIV and YALHIV, reinforcing the necessity for a tailored HIV programme to enhance treatment adherence and VLS. The findings emphasised the importance of multi-sectoral collaboration, involving diverse stakeholders and multiple levels of government, in addressing the specific needs of this demographic. Additionally, the study revealed a 45.4% (75/165) consensus on the theories, tools, strategies, and guidelines required for the effective management of this age group. The development of an HIV programme tailored for OALHIV and YALHIV is a critical step toward optimising interventions to achieve VLS targets (95%) set for this age group. This process necessitates a collaborative effort that integrates appropriate theoretical frameworks, evidence-based strategies, standardised guidelines and tools. Nevertheless, its feasibility and impact require further evaluation.