Healthcare professionals’ perspectives on health literacy competencies for adolescents living with HIV: Findings from a modified e-delphi study in rural KwaZulu-Natal, South Africa

Background Adolescents living with HIV (ALHIV) in sub-Saharan Africa still encounter substantial challenges in managing their health, often experiencing lower rates of virological suppression compared to adults. In KwaZulu-Natal, South Africa, where HIV disproportionately impacts youth, strengthening health literacy and self-management skills is essential for successful HIV treatment.Aims To identify and gain consensus on the key health literacy competencies and self-management skills that health care professionals believe are essential for ALHIV to effectively manage their condition.Methods We utilised a modified e-Delphi method, to gather insights on key areas of health literacy from health care professionals in rural KwaZulu-Natal. A total of 2 survey rounds were completed by 19 participants drawn from the local public health clinics with a predefined consensus criteria as a median score with 7–9 range on a 9-point Likert scale.Results Findings reflect healthcare professionals’ perspectives on the competencies adolescents living with HIV (ALHIV) should possess. There was strong consensus on the importance of adolescents understanding disease-specific information, particularly viral load and CD4 count, which are essential for informed health decisions and treatment adherence. In contrast, there was lower agreement on adolescents’ ability to comprehend developmental and psychological issues, highlighting a gap in the cognitive and decision-making skills necessary for effective self-management. Additionally, the study found a limited focus on sexual and reproductive health and lifestyle factors in the core competencies.Discussion While these findings suggest the need for additional support for ALHIV, they also highlight the role of healthcare providers in facilitating age-appropriate, cognitively tailored education. These findings underscore the need for health literacy interventions that not only build adolescents’ knowledge and self-management capacity but also support providers in communicating complex health information in developmentally appropriate and contextually relevant ways. Ultimately, improving health literacy among ALHIV requires strengthening both adolescent and provider capacities to improve health outcomes and achieve the UNAIDS 95-95-95 targets.