Roles and Responsibilities of Expert Clients in Adolescent HIV Service Delivery in Eswatini: A Conventional Content Analysis

Abstract BackgroundLike in other countries throughout sub-Saharan Africa, Eswatini employs a cadre of HIV-positive lay health workers known as expert clients (ECs) for the purpose of mitigating human resource gaps in HIV care. However, there are no insights in the literature describing the scope of their contribution to adolescent-specific HIV service delivery. Therefore, we aimed to elucidate the specific roles and responsibilities of ECs with regard to service delivery among adolescents living with HIV in Eswatini, and to provide recommendations for enhancing adolescent service provision among ECs and similar lay health workers throughout low- and middle-income countries. MethodsAn exploratory qualitative descriptive methodology using conventional content analysis was employed to meet our study aims. We recruited 20 expert clients and 12 key informants (i.e., program managers, program coordinators, and nurses) to participate in semi-structured interviews, and we arranged four focus group discussions among adolescents living with HIV with 7 to 10 participants per focus group. ResultsAdherence counseling in clinical and community settings was considered paramount to the roles and responsibilities of ECs with regard to adolescent-specific HIV service delivery. The following recommendations were made to enhance EC service delivery practices among adolescents: a) training in adolescent developmental, sexual, and reproductive needs, b) training to enhance clinical knowledge and skills, c) additional work equipment and compensation, and d) more parent and guardian engagement in their work. ConclusionsWhile expert clients meet the needs of HIV-positive adolescents in several capacities, ECs require additional resources, skills, and training to improve their work, especially within the realm of sexual and reproductive health. Future research is needed to evaluate the impact of EC service delivery on adolescent health outcomes.