Adolescent-focused interventions lead to 30% increase in viral suppression in Namibia and 20% increase in Nigeria


Successful approaches to managing HIV in adolescents and young adults were reported by researchers from two countries in sub-Saharan Africa at the 11th International AIDS Society HIV Science Conference this week.

Dr Toivo Shikesho from the Namibian Ministry of Health and Human Services reported a 30% increase in viral suppression in people aged 15 to 24, while Dr Franklin Emerenini from Columbia University reported presented the results from Nigeria, where there was a 50% increase in viral prevalence. load test and a 20% increase in suppression in 10-24 year olds. Both countries have implemented targeted community interventions targeting the specific needs of adolescents and young adults.

Adolescents and young people (aged 15 to 24) accounted for about a third of all new HIV infections in sub-Saharan Africa. Among adolescents aged 10-19 in the region, only around 43% are in care, 31% remain in care, and 30% are virally suppressed. AIDS-related illnesses are the leading cause of death among adolescents living in sub-Saharan Africa.

Namibia

In 2018, viral load suppression among people living with HIV in four high HIV prevalence regions of northern Namibia (including Kavongo, Omusati and Oshikoto) was 92% overall. However, only 44% of adolescents and young adults (aged 15-24) have experienced viral suppression in these areas.

Glossary

virological suppression

Stopping the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction in viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.

directly observed therapy (DOT)

When a healthcare professional watches a person take each dose of a medicine, to verify that all doses are being taken as prescribed.

community environment

In health care parlance, something that happens in a “community setting” or in “the community” happens outside of a hospital.

Shikesho shared the results of a collaborative quality improvement intervention including 25 treatment centers (providing care to 66,400 people living with HIV) in the three aforementioned regions to improve viral suppression in adolescents and young people. adults between August 2018 and December 2020.

The intervention consisted of a dedicated team of three professionals (an antiretroviral therapy (ART) nurse, data clerk, and physician) at each facility, who introduced new approaches and monitored viral suppression rates by submitting data. to a central source. This team attended four learning sessions and received support from regional and national quality improvement coaches.

Strategies included using high viral load registers (to monitor those who had not achieved viral suppression, implemented at all sites), improving adherence counseling (80% of sites) , directly observed therapy (52%), pill organizers (32%). , initiating or strengthening existing adolescent membership clubs (64%) and ensuring timely transition to another ART regimen if necessary (all sites). Institutional teams reported specific strategies that have been successfully implemented to encourage higher rates of viral suppression (less than 1000 copies / ml).

While only 407 teens and young adults had achieved viral suppression initially (44%), that figure rose to 719 (74%) by the end of 2020.

“A collaborative quality improvement approach applied with a dedicated team of healthcare workers and coaches has improved viral load suppression in the 15-24 age group,” concluded Shikesho. “Institutional teamwork and quality improvement learning sessions were critical to the success of the initiative. “

Nigeria

Adolescents and young adults make up about 7% of people living with HIV in Nigeria and often have poor treatment outcomes.

Emerenini presented the results of Operation Triple Zero, carried out in four Nigerian states (Adamawa, Akwa Ibom, Cross River and Niger) aimed at adolescents and young adults living with HIV, aged 10 to 24 years from April to September 2020. The “triple zero” refers to the three key targets of the intervention: zero missed appointments, zero missed doses and zero viral loads.

Strategies used to achieve these goals included adolescent-focused case management, peer support, specific behavioral interventions aimed at targeting adherence issues, and the inclusion of rewards that appeal to these age groups, such as free Wi-Fi and games.

A total of 33 health facilities in the four states participated in the intervention. At these sites, 4,617 adolescents and young adults were enrolled in the program (80% of all eligible applicants), of whom 66 were trained as ‘youth champions’ – trained to help health workers provide support. adherence, to help new patients navigate the clinic and to provide peer mentoring.

Results at the end of the intervention period were compared with indicators from the previous period, October 2019 to March 2020. Emerenini reported impressive results on all measures compared to the pre-intervention period. For all age groups, about 99% of participants were on an optimal ART regimen at the end of the procedure. This represents a 62% increase for 10 to 14 year olds, a 61% increase for 15 to 19 year olds and a 53% increase for 20 to 24 year olds.

“Adolescents and young people can easily miss the crowds and require specific tailored interventions to facilitate adherence. “

The number of people having a viral load test increased by 50%, reaching 78% of adolescents and young adults.

Viral suppression increased significantly at the end of the intervention period for all age groups. In September 2020, it was 82% among 10-14 year olds (an increase of 15% from baseline), 83% among 15-19 year olds (an increase of 31%) and 85% among the 20 to 24 year olds (a 17% increase).

In addition to involving adolescents and young people more directly, Emerenini attributed the success of the intervention to strategies similar to those used in Namibia, such as keeping a list of those who had not achieved suppression. viral, improving adherence counseling (both for caregivers and young people, in person and virtually) and ensuring that optimal treatment regimens are used. In addition, he mentioned specific changes to the healthcare system, such as setting up dedicated clinic hours (such as weekends) and making clinics more suitable for adolescents by providing free Wi-Fi. Fi and free games. In addition, health workers were trained on how to best meet the needs of adolescents without being judgmental.

“Adolescents and young people can easily miss the crowds and require tailored and specific interventions to facilitate adherence,” Emerenini concluded. “These findings validate the use of integrated, asset-based strategies to improve HIV treatment outcomes in adolescents and young people living with HIV.

About Bradley J. Bridges

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