Table 2.

Illustrative qualitative excerpts regarding barriers and facilitators to adolescent retention in HIV care, from study participants.^†

Excerpt Number	Barrier or facilitator to retention	Excerpt
	Adolescent- and family-level factors
1	Stigma	Stigma can even kill someone. My sister has been a victim of stigma. After our parents passed on, it came out that she has HIV. Even family members started sidelining her, telling her, ‘will you live?;’ mocking and discouraging her. It hurt her to a level where she was saying, ‘let me just die.’ It made her [school] performance go so far down. When you would ask her the reason, she couldn’t say, but it was all stigma. Sometimes when she had to go to clinic, she would say that she is going somewhere else, so that [family] would not know. Even if she is sick, she doesn’t go to [hospital]. It stigmatized her to a level that she saw that this thing is so bad, it is better to die. (Brother, adolescent female)
2	Poverty	You know, we rushed to this place of yours just to prolong our days, but some of us don’t have decent lives – tunakaa mbaya. (Mother, adolescent male)
3	Trauma, conflict, or abuse	I got married out of desperation. I didn’t have a caring parent. I was being mistreated [by a step-parent]. So I decided to start my life. I didn’t look at the consequences. That is why I rushed to marriage, because there was no one else who could help me. [My step-parent wouldn’t bring me to clinic] – never, not one day. (Adolescent female)
4	Mental health challenges, including suicidality and passive suicidality	[After a fight with the doctors,] I refused to come back to clinic. I didn’t know [death] will take longer; what I knew was I was leaving the clinic and we will die immediately. I was like someone who had given up on life and wished my child and I would die. I knew we will be gone because it is the medication which was prolonging our lives, because we had been told never to stop taking the medicines. I even started drinking. The child was okay [at that time. After two years out of care,] the child became very sick. (Mother, adolescent male)
	Clinic-level factors
5	Relationships with clinic staff	The [clinic staff] are making her at least feel comfortable, because she feels someone cares for her. Sometimes she feels more loved than even being at home. When she goes to the clinic, she says that at least she gets someone who tells her, ‘I love you,’ or, ‘you are well, you will make it.’” (Brother, adolescent female)
6	Peer support interventions	Now that he is a peer, he won’t feel that he is alone. You know you may think that it is you alone and life has to end from there. So as you get people of your age, and they are telling you that life is still possible, life is positive and you can still make it. It can make someone think ahead [to the future]. (Father, adolescent male)
	School-level factors
7	Disclosures at school	One day, I coughed in class and the teacher said, ‘You see this one, she has HIV.’ I almost cried. (Adolescent female)
8	Requesting absence from school	When she asked the teacher [for permission to] attend clinic, the teacher demanded which clinic it was for. She could not disclose this to the teacher. The teacher told her to finish the exams first and go to clinic later. So, it was difficult for her to go. (Brother, adolescent female)
	Societal factors
9	Desire for financial interventions	[With a financial intervention], I would just start my business. Because with the job I do sometimes I am not given time to come to clinic, and you don’t feel like leaving it, and there are only two options, you leave the clinic or leave the job. (Adolescent female)
10	Desire for stigma reduction	[Stigma reduction] will make this child feel appreciated despite having HIV. If they feel they are part of the community, it will enable the child to continue well with his/her care. (Father, adolescent male)

^†Numbered excerpts are referenced in the manuscript text.