Gaps and opportunities for strengthening HIV support in schools for youth living with HIV


BACKGROUND: As a result of optimized HIV treatment, youth living with HIV (YLHIV) have improved survival and are enrolled in schools. YLHIV spend most of their time in schools, making schools an important venue to optimize health and social outcomes.
METHODS: We conducted surveys with secondary/high schools in Kenya to determine policies/practices and staff training on HIV. Selected schools were in counties with varying adult HIV prevalence (Homa Bay 21%, Nairobi 6%, Kajiado 4%). Chi-squared tests and logistic regression were used to compare policy availability and staff training by HIV prevalence and school type (day or boarding).
RESULTS: Of 506 schools, we surveyed 97 (19%); (35, 37 and 25 in Homa Bay, Nairobi, and Kajiado, respectively). Many schools had boarding facilities (58 [60%]). Median student population was 400 (IQR: 200, 750]) and student:staff ratio 13 (IQR: 9, 16).
While 85% of schools required disclosure of chronic illnesses, only half (49%) had confidentiality policies with significantly higher frequency of policy availability in higher HIV prevalence regions (Homa Bay [91%], Nairobi [57%], Kajiado [32%], p=0.004). Similarly, while a majority (81%) had clinic attendance policies; and policy availability was higher in higher HIV prevalence regions (Homa Bay [100%], Nairobi [81%], Kajiado [56%], p<0.001). Only 48 (49%) schools had medication use policies; significantly more in boarding than day schools (64% versus 28%, p=0.001).
Eighty percent of schools had staff trained in counseling, 32%, in HIV prevention 22%, mental health 31% stigma reduction, 36% psychosocial support, and 35% confidentiality. Overall, 24 (25%) schools had staff dedicated to health, 11 (46%) of which had staff trained in HIV care/treatment. Boarding schools were more likely to have staff trained in HIV prevention/care/treatment compared to day schools (75% vs 25%, p=0.03).
There were significant regional differences in student populations, staff:student ratio and HIV training (all highest in Nairobi).
CONCLUSIONS: In this survey of Kenyan schools, there were notable gaps in HIV care policies and training, despite high HIV burden. Implementation of national policies on confidentiality, medication use, and clinic attendance as well as HIV training in schools may improve outcomes for YLHIV.

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