Functioning and effectiveness of a differentiated care model: a qualitative study of HIV youth clubs in Kinshasa.

In 2023, an estimated 2.38 million children and adolescents aged 0-19 were living with HIV globally, most in sub-Saharan Africa. In the Democratic Republic of Congo (DRC), stigma, weak psychosocial support, and disclosure challenges undermine adherence among adolescents. In response, Médecins Sans Frontières and Jeunesse Espoir launched youth clubs in Kinshasa in 2019 to promote adherence and peer-based psychosocial care. This qualitative study explored young people's perspectives on these clubs and their impact on treatment, identity, and daily life. We conducted 46 semi-structured interviews, four focus groups, and 16 observational sessions across four youth HIV clubs with adolescents and young adults aged 14-24, alongside healthcare providers and peer facilitators. A participatory Photovoice component engaged 10 youth in documenting their experiences through photography and collective reflection. The clubs were described as safe spaces that fostered peer solidarity, HIV knowledge, adherence strategies, and emotional well-being. Photovoice themes such as "hope" and "agency" highlighted processes of identity reconstruction. While youth valued peer support, they also reported persistent barriers including stigma, limited family involvement in disclosure, and lack of structured transition to adult care. Findings suggest that youth clubs operate as psychosocial ecosystems supporting adherence and self-acceptance, and scaling up this model could strengthen adolescent HIV care.