Mapping Health Policies for Optimum Service Delivery to Adolescents on HIV treatment in Zambia: a document review

Abstract

Introduction Adolescents living with HIV (ALHIV) are a highly vulnerable population in HIV care, facing unique service delivery challenges due to their developmental stage, psychosocial needs, and various barriers to accessing comprehensive healthcare. Despite significant advances in HIV treatment regimens, ALHIV report lower rates of viral suppression compared to other age groups reflecting sub-optimal adherence and lower engagement in care. ALHIV are considered a priority population in the fight against HIV globally due to high risk of HIV infection and poor treatment outcomes. It is therefore imperative that the specific needs of ALHIV be addressed in health policies that direct service delivery. The current paper reports on the adequacy of health policies and guidelines that direct the provision of HIV care and treatment services for ALHIV in Zambia, as measured against global recommendations for best practice. Methods We conducted a review of national health policies and guidelines (N = 10) that relate to HIV service delivery for ALHIV in Zambia and assessed these against global policy recommendations (N = 6) of which Zambia is a signatory. We mapped the content of national policies using the World Health Organization’s (WHO) health systems framework. Results The Zambian policies are consistent with global recommendations for health service delivery for ALHIV - including psychosocial support, peer support, mental health services, and sexual and reproductive health education. Further the country’s health legislation advocates for a change in the age of consent for health services and comprehensive sexual education in schools, as globally recommended. However, there is lack of intentional inclusion of adolescents, caregivers and community stakeholders in policy development in Zambia. With respect to health financing, the national policies promote the integration of HIV financing with other health financing mechanisms but lack dedicated funding for adolescent HIV services and advocacy for health insurance tailored to their needs. Community involvement is emphasized through youth advisory boards, training and support groups, but high-level engagement in program design is lacking. Conclusions Zambian health policies and guidelines align with global recommendations to optimize health service delivery for ALHIV in four of the six WHO Health Systems building blocks. However, significant gaps remain in areas such as health legislation, financing and community engagement.