Addressing barriers and facilitators to family planning uptake among adolescent girls and young women in the anticipated context of long-acting antiretroviral therapy (LA ART)

Adolescent girls and young women (AGYW) aged 15–24 years bear a disproportionate HIV burden globally, with nearly twice as many AGYW living with HIV as adolescent boys and young men. Despite a 63% reduction in new infections since 2000, 210,000 new infections occur annually among AGYW, four times higher than the 2025 global target of 50,000. Despite emerging opportunities for integrated service delivery, including now through long-acting antiretroviral therapy (LA ART), significant gaps remain in understanding barriers and facilitators to family planning (FP) access among AGYW living with HIV from adolescent and stakeholder perspectives. We conducted focus group discussions (FGDs) with four stakeholder groups in western Kenya (November 2021–April 2022): adolescents and young people living with HIV (AYPLHIV), healthcare providers, advocates, and policymakers. Participants were recruited through purposive and snowball sampling from Rafiki Clinic at Moi Teaching and Referral Hospital in Eldoret, Kenya, and transcripts were analyzed using inductive and deductive approaches organized by the socioecological model (SEM). Seven FGDs were conducted with 58 participants total. Four themes emerged across SEM levels: at the policy level, parental consent requirements created policy-level implementation challenges; at the health systems level, barriers included provider stigma, inadequate youth-friendly services, and supply chain gaps; at the interpersonal level, peer mentors were trusted but could perpetuate misinformation, parental disapproval persisted, and male partner involvement was variable, and at the individual level, adolescents preferred discreet, low-maintenance methods, though myths, side effect fears, and procedural anxiety influenced choices. Effective interventions require comprehensive approaches combining policy clarification, provider training, service integration, male partner and parental engagement, evidence-based peer mentor programs, and removal of cost barriers to long-acting reversible contraceptives. Integration of FP within LA ART delivery platforms offers promising opportunities to normalize contraceptive use and improve reproductive health outcomes for AGYW living with HIV.