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. 2025 May 20;25(1):723.
doi: 10.1186/s12913-025-12868-6.

Mapping health policies for optimum service delivery to adolescents on HIV treatment in Zambia: a document review

Kaala Moomba  1 , Talitha Crowley  2 , Brian Van Wyk  3
Affiliations

Mapping health policies for optimum service delivery to adolescents on HIV treatment in Zambia: a document review

Kaala Moomba et al. BMC Health Serv Res. .

Abstract

Introduction: Despite significant advances in HIV treatment regimens, adolescents living with HIV (ALHIV) report lower rates of viral suppression compared to other age groups, reflecting sub-optimal adherence and lower engagement in care. In Zambia, adolescents lag behind in meeting the 95-95-95 targets for HIV care, when compared to adults. It is imperative that the specific needs of ALHIV are addressed in health policies that direct service delivery. This paper reports on Zambian health policies (policy documents and guidelines) that direct the provision of HIV care and treatment services for ALHIV, by assessing their alignment with recommendations for global best practice as presented in global health policies. We contextualize the policy review within the problem that exists in Zambia with respect to poor performance of the adolescents on the HIV cascade.

Methods: We conducted a document review of national health policies and guidelines (N = 10) that relate to HIV service delivery for ALHIV in Zambia and assessed these against the global health policies (N = 6) of which Zambia is a signatory using the four-step READ methodology for document review in health policy research. We used thematic content analysis to develop key themes that describe the components of health service delivery according to the World Health Organization's (WHO) health systems framework, and comparative analysis to map national health policy against global health policies.

Results: The Zambian policies are aligned with global recommendations for health service delivery for ALHIV by including psychosocial support, peer support, mental health services and sexual and reproductive health education in their offering. In addition, Zambian 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 a lack of deliberate involvement of adolescents, caregivers and community stakeholders in policy development. 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. While community involvement is emphasised through youth advisory boards, training, and support groups, there is a notable absence of intentional adolescent engagement at the high-level program design stage.

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, as evidenced in the relevant global health policies. However, significant gaps remain in areas such as health legislation, financing and community engagement.

Keywords: Adolescents; Document review; HIV treatment; Health policies; Legislation; Mapping; Service delivery.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The present study received ethical approval from the health research ethics committees of the University of the Western Cape (BM_24_3_4), and Mulungushi University School of Medicine (SMHS-MU2-2024-04). No informed consent was required because all documents reviewed were in public domain. No direct contact was required or made with participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of document selection process: adapted from reference [24]
Fig. 2
Fig. 2
Scoring Zambian policies on adolescents and HIV treatment against global policy and recommendations
See this image and copyright information in PMC

References

    1. MOH. Zambia Adolescent Health Strategic Plan 2022–2026. 2022. Available from: https://www.unicef.org/zambia/media/5881/file/Zambia-National-Adolescent....
    1. Armstrong A, Nagata JM, Vicari M, Irvine C, Cluver L, Sohn AH, et al. A global research agenda for adolescents living with HIV. J Acquir Immune Defic Syndr. 2018;78(1):S16–21. - PMC - PubMed
    1. WHO. Global strategy for women’s, children’s and adolescents’ health (2016–2030): early childhood development. World Heal Organ. 2018;03 de mar de 2023:1–9 Available from: https://www.who.int/publications/i/item/the-global-strategy-for-women-s-....
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