Youth access and utilization of HIV services in Homa Bay, Kenya: protocol for a mixed-methods study

Youth aged 15-24 years continue to experience substantial HIV-related vulnerability, particularly in sub-Saharan Africa. Although HIV prevention, testing, treatment and support services have expanded, barriers related to knowledge, stigma, confidentiality, affordability, geographic accessibility, provider attitudes and the organization of health services continue to affect young people's engagement with HIV services. Homa Bay County has one of the highest HIV burdens in Kenya, yet evidence on the factors influencing youth access to and utilization of HIV services in the county remains limited.

This study aims to assess access to and utilization of HIV services among youth aged 15-24 years in Homa Bay Town Sub-County, Kenya, and to examine individual, household, community and health-system factors associated with utilization.

A mixed-methods cross-sectional study will be conducted among youth aged 15-24 years residing in Homa Bay Town Sub-County. The quantitative component will target 400 youth recruited through a multistage sampling approach involving ward-based stratification, selection of community-based clusters, and participant selection within selected clusters. Quantitative data will be collected using a structured researcher-administered questionnaire. The qualitative component will comprise focus group discussions with youth and key informant interviews with healthcare providers, peer educators and community gatekeepers. Quantitative data will be analysed using R. Descriptive statistics and bivariate analyses will be followed by multivariable logistic regression to identify factors independently associated with HIV service utilization. Qualitative data will be analysed thematically. Findings from the two components will be integrated using narrative synthesis and thematic matrices.

The study will generate context-specific evidence on individual, social and health-system factors influencing youth HIV service utilization in Homa Bay Town Sub-County. The findings will inform the design and strengthening of youth-friendly HIV services and contribute to implementation strategies aimed at reducing barriers to HIV prevention, testing and care.