Health system challenges and adolescent healthcare: Insights from Kamuli General Hospital in East-Central Uganda. A qualitative study

Background Despite calls for concerted effort towards adolescent health, data on the health system challenges among adolescents living with HIV/AIDS (ALWHA) accessing care at Kamuli General Hospital (KGH) is scanty. Objective To assess the system challenges influencing access to care among ALWHA at Kamuli General Hospital Antiretroviral Treatment (ART) Clinic. Methods In a cross-sectional qualitative design, adolescents were stratified by age (< 18 years or ≥ 18 years), gender and in- or out of school. Thereafter, 6–10 participants with-in each stratum were enrolled into 10 Focus Group Discussions. One member from the Hospital Management Board, the District HIV/AIDS Focal Person and six key personnel at the ART Clinic were purposively enrolled. A checklist was used to capture data on adolescents’ privacy and confidentiality while accessing care as well as the Information, Education and Communication messages displayed in KGH targeting adolescents. A total of 74 ALWHA were enrolled into the study. Results Service delivery for ALWHA was fragmented, with health education as the main service, minimal sexual and reproductive health care, no preconception services, and low family planning uptake (~ 5%) due to referrals. Mental health care was limited to screening and referral. Key challenges included disrespectful care, confidentiality breaches, and poor service integration. Essential services were external, psychosocial support relied on undertrained peers, and systemic gaps included poor planning, resource misallocation, and limited digital access. Conclusion and recommendation : ALWHA services remain fragmented and inadequate, with limited comprehensive care, low family planning uptake, weak integration, and systemic inefficiencies undermining quality, confidentiality, and health outcomes. Strengthening integrated adolescent-friendly services, improving provider training, expanding SRH and mental health care, and ensuring confidentiality are recommended