User-provider experiences of the implementation of KidzAlive-driven child-friendly spaces in KwaZulu-Natal, South Africa

BACKGROUND: KidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. Through this intervention, 10 child-friendly spaces were created in 10 primary healthcare centres (PHCs) in KwaZulu-Natal to enhance child-centred HIV care. However, the user-provider experiences of these child-friendly spaces in these facilities have not been explored. This paper addresses this gap. METHODS: We conducted qualitative interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained healthcare workers (HCWs) (n = 20) using and providing child-friendly spaces, respectively. Data were generated, using a semi-structured interview guide printed in both English and IsiZulu. The interviews were audio-recorded transcribed and translated to English by a research team member competent in both languages. Data were imported to NVivo 10 for thematic analysis. The COREQ checklist was used to ensure that the study adheres to quality standards for reporting qualitative research. RESULTS: Child-friendly spaces contributed to the centredness of care for children in PHCs. This was evidenced by the increased involvement and participation of children, increased PCGs’ participation in the care of their children and a positive transformation of the PHC to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children. CONCLUSION: Child-friendly spaces promote HIV positive children’s right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children’s HIV-related health outcomes.