THE ROLE OF SOCIAL PRESCRIBING IN ENHANCING ADOLESCENT CASE FINDING FOR HIV IN LOW- AND MIDDLE-INCOME COUNTRIES (LMICs)
Emmanuel Vincent MD, MPH, PMP
Public Health Expert | Data Scientist | Global Health Program Manager | Driving Impact through Data & Innovation
INTRODUCTION
The burden of HIV among adolescents and young people in low- and middle-income countries (LMICs), particularly in Africa, remains a critical public health challenge. Adolescents account for a significant proportion of new HIV infections globally, with sub-Saharan Africa bearing the highest burden (UNAIDS, 2022). Despite advancements in HIV prevention, diagnosis, and treatment, adolescents continue to experience lower rates of testing, late diagnosis, and poor retention in care compared to adults (WHO, 2021). Barriers such as stigma, lack of youth-friendly health services, and structural inequalities contribute to poor health outcomes among this demographic (UNICEF, 2020).
Social prescribing is a structured, non-clinical intervention that involves linking individuals from hospital settings to community-based support systems that focuses on addressing the root causes (mostly socioeconomic risk factors) of their illnesses. This model has been successfully applied in high-income settings for managing chronic illnesses and mental health conditions, and its application in adolescent HIV programs in LMICs presents a novel opportunity to strengthen linkage to care (Husk et al., 2019). By leveraging existing adolescent-focused community health structures, such as Operation Triple Zero (OTZ) clubs and youth health clubs, social prescribing can enhance the accessibility, acceptability, and effectiveness of HIV interventions for young people, particularly driving the improvement in adolescent case finding and retention in HIV programs.
Understanding Social Prescribing in the Context of Adolescent Health
Social prescribing is an emerging healthcare approach that connects individuals to non-medical services to improve overall well-being. It involves healthcare professionals referring patients to community resources such as youth clubs, social networks, or peer support groups to address their broader health and social needs. In the context of adolescent HIV programs, social prescribing can serve as a vital strategy to enhance case finding and retention by leveraging existing community-based adolescent health structures. This entails establishing a structured referral system that enables healthcare facilities with limited expertise in adolescent-focused service provision to connect adolescents with trained champions. These champions would facilitate referrals to existing community-based support structures, such as OTZ Clubs, Health Clubs, and other adolescent-focused social support networks. Within these platforms, adolescents can access a range of tailored services delivered by trained peers, ensuring comprehensive and youth-friendly care.
CASE STUDY: WHIZZKIDS UNITED IN SOUTH AFRICA
WhizzKids United, a program based in Durban, South Africa, exemplifies the application of social prescribing in adolescent HIV care. Founded by Marcus McGilvray, an HIV nurse specialist, the program uses football (soccer) as an educational medium to facilitate healthy behavior change among youth. The initiative includes the Health Academy, an adolescent-friendly clinic offering free HIV testing, antiretroviral treatment, and psychosocial support. By integrating sports with health education and services, WhizzKids United creates a supportive environment that encourages adolescents to engage in HIV prevention and care.
THE CHALLENGE OF ADOLESCENT HIV CASE FINDING AND RETENTION
Adolescents and young people (AYP) account for a significant proportion of new HIV infections globally, yet they remain one of the most underserved populations in HIV prevention, testing, and treatment services. According to UNAIDS (2023), adolescents aged 10–19 represented 10% of the total population living with HIV but accounted for 14% of AIDS-related deaths. The challenge of adolescent HIV case finding and retention is particularly pronounced in low- and middle-income countries (LMICs), where systemic barriers hinder engagement in care.
Moreso, many healthcare facilities in LMICs lack dedicated adolescent-friendly services, making it difficult for young people to access and remain engaged in care. Some of these identified barriers include:
1. Stigma and Discrimination
HIV-related stigma remains a persistent barrier preventing adolescents from accessing HIV services. Fear of disclosure, judgment, and discrimination from healthcare workers and community members discourages young people from seeking testing and treatment. This stigma is often exacerbated by cultural norms that associate HIV with moral failure, leading to self-stigmatization and reluctance to engage with health facilities.
Impact on Case Finding and Retention
2. Inconvenient Service Delivery Models
Most healthcare facilities operate on rigid service delivery models that do not accommodate adolescents’ needs. Challenges such as inflexible clinic hours, long wait times, lack of confidentiality, and absence of adolescent-friendly providers make it difficult for young people to engage in HIV services.
Impact on Case Finding and Retention
Low Testing Rates: Traditional facility-based testing models miss adolescents who are reluctant to seek care. Data from the Demographic and Health Surveys (DHS) show that only 30–40% of sexually active adolescents in LMICs have ever tested for HIV, compared to 60–70% of adults (UNAIDS, 2022).
Missed Appointments: In Tanzania, 42% of adolescents living with HIV reported missing clinic visits due to school schedules and inconvenient service hours (WHO, 2023).
Attrition in Care: Adolescents in standard HIV clinics have higher dropout rates (37%) compared to adult cohorts (15%) due to facility-based structural barriers (PATA, 2022).
3. Limited Awareness and Engagement
Many adolescents are unaware of available HIV services or do not perceive themselves at risk of infection. Misinformation, lack of comprehensive sexuality education, and cultural taboos around discussing sexual health contribute to low HIV testing and treatment rates among young people.
Impact on Case Finding and Retention
Late Diagnosis: UNAIDS (2023) reports that over 50% of adolescents diagnosed with HIV in LMICs are diagnosed late, when they are already symptomatic.
Low Prevention Uptake: Studies from Nigeria and Ethiopia show that less than 20% of adolescents can correctly identify HIV prevention strategies such as PrEP (PATA, 2023).
Poor Treatment Literacy: A survey conducted in Mozambique found that only 32% of HIV-positive adolescents understood the importance of adherence to ART (ICAP, 2022).
STRENGTHENING LINKAGES THROUGH SOCIAL PRESCRIBING
By integrating social prescribing into HIV programs, healthcare providers can establish strong referral pathways between non-adolescent-friendly health facilities and adolescent-focused community health structures such as OTZ (Operation Triple Zero) clubs, health clubs, and adolescent-friendly clinics. This approach has several key benefits:
1. Improved Access to Adolescent-Friendly Services
Social prescribing can ensure that adolescents diagnosed in general health facilities are linked to supportive, youth-centered environments that offer peer-led interventions, psychosocial support, and treatment literacy. This approach can enhance the likelihood of early case finding and improve treatment adherence.
2. Leveraging Community-Based Organizations and Peer Networks
Community-based organizations running adolescent-friendly health programs can be valuable partners in case finding and retention efforts. Through social prescribing, adolescents who might be hesitant to engage with formal healthcare systems can be referred to these organizations, which provide a less stigmatizing and more supportive environment for HIV testing and care.
3. Enhancing Retention Through Psychosocial Support
Many adolescents disengage from HIV care due to social isolation and mental health challenges. Adolescent health clubs and OTZ clubs offer safe spaces where young people can connect, receive mentorship from peers, and participate in activities that reinforce adherence to treatment.
4. Increasing Community Engagement and Awareness
Social prescribing also serves as an avenue for increasing awareness about adolescent HIV services within communities. By working with schools, religious institutions, and youth organizations, healthcare facilities can ensure that adolescents are aware of the referral system and the availability of adolescent-friendly HIV services.
IMPLEMENTING SOCIAL PRESCRIBING FOR ADOLESCENT CASE FINDING
To effectively implement social prescribing as part of adolescent HIV programs in LMICs, the following strategies should be adopted:
1. Developing Structured Referral Pathways
Healthcare facilities without adolescent-friendly services should establish formalized referral systems to adolescent health clubs and community clinics. This can be done through:
2. Engaging Peer Navigators and Community Health Workers
Peer navigators and community health workers play a crucial role in facilitating social prescribing. They can:
3. Integrating Digital Health Solutions
Digital platforms, such as mobile health apps and SMS reminders, can be used to streamline social prescribing efforts. Adolescents can receive automated referrals, appointment reminders, and peer support through digital platforms tailored to their needs.
4. Monitoring and Evaluating Outcomes
To assess the effectiveness of social prescribing in adolescent case finding and retention, key performance indicators should be established, including:
Conclusion
Social prescribing presents a transformative opportunity to enhance adolescent HIV case finding and retention in LMICs by bridging the gap between traditional healthcare facilities and community-based adolescent-friendly health structures. By implementing structured referral pathways, leveraging peer support networks, and integrating digital health solutions, social prescribing can improve adolescent access to HIV services, reduce stigma, and promote long-term retention in care. As HIV programs evolve, the integration of social prescribing into national adolescent health strategies can be a game-changer in addressing the epidemic among young people in Africa and beyond.
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Medical Doctor| Public Health & Development Specialist| Strengthening Health Systems
3moI totally agree with you, we must make very conscious effort at providing adolescent friendly services to meet the health needs of this at risk population.