Access and retention to treatment for adolescents living with hiv
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Access and retention to treatment for adolescents living with hiv
- 1. Access and Retention to Treatment for Adolescents Living with HIV By: Elizabeth Okoth – Program Manager
- 2. Outline • Background • Guiding Principles • Intensive Case Finding Towards enhancing Access • Strategic Interventions for Enhancing Adolescents Retention • Case of EGPAF PAMOJA Homa Bay Project 2
- 3. Back Ground – The Kenya Situation • 29% of all new HIV infections in Kenya are among adolescents & youth • About 16% of PLHIV in Kenya are adolescents & youth • Young women (15 –24yrs) contribute 21% of all new infections • HIV-positive adolescent girls face a much higher risk of poor maternal & infant outcomes& increased risks for MTCT • AIDS-related deaths is the leading cause of death among adolescents in Kenya (9,720 died in 2014) • Only 23.5% of adolescents aged 15-19 years know their HIV status • Low disclosure, poor adherence & stigma among adolescents • Benefit of early treatment with an overall 75% decline in mortality &ART with viral suppression reduces risk of sexual transmission of HIV 3
- 4. Guiding Principles to Increasing Access & Retention • Recognition of heterogeneity of adolescents and their needs • Building and using of evidence base & best practices to inform interventions • Combination approach to addressing adolescents needs & Strengthening referrals to other social/protective services • Adolescent engagement in advocacy, design and implementation of services and policy directions • “National Adolescent Package of Care as SOP” • Commitment through strategy and policy
- 5. Intensified HIV case-finding for adolescents LHIV • Screen all adolescents that present at facility & provide PITC • Test all adolescents in inpatient, TB, nutrition and STI clinics, pregnant adolescents, married & adolescents with children • Scale up family- centred model to test and treat adolescents with HIV-infected parents & OVC • Universal testing in epidemic hotspots to increase coverage • Piloting and evaluating new approaches such as self-testing • SRH approaches that combined STI and HIV screening and partner testing services in adolescent friendly manner • Engaging HTS Counsellors to focus on adolescents
- 6. Use of EBIs in Enhancing Identification • Evidence-informed Behavioral Interventions (EBIs) are interventions that have been rigorously evaluated and have been shown to have significant efficacy • EBIs that target adolescents such as SHUGA, Sister to Sister and RESPECT-K have strong HTS component • SHUGA: A mass multimedia behavior change communication initiative targeting youth ages 15 to 24 with HIV prevention messages and linking them to vital services • Sister to Sister: Individual level risk reduction intervention for sexually active women with focus on self efficacy, safer sex negotiation skills, & encourages HTS
- 7. Linkage Improve linkage and ensure enrolment of at least 90% of HIV- infected adolescents on HIV care • “Everything stops” until the adolescent is linked (enrolled) • Recruit and deploy linkage staff / Peer Educators (including adolescent peer educators) • Strengthen facility linkage teams and client flow • Support use of referral tools
- 8. Enhancing Adolescents Retention to Treatment • Engagement of adolescents through facility, County & Country forums to support the design and implementation of adolescent- focused clinical and support services • Graduated disclosure support for HIV-infected adolescents • Enhanced adherence support including treatment literacy and engagement of caregivers • Strategies for transitioning to adolescents care & treatment and from adolescents to adult care and treatment • Enhancing mHealth and social media platforms to send appointment reminders and strengthen the client-facility feedback loop
- 9. Enhancing Adolescents Retention to Treatment • Adolescents psychosocial support groups with age and developmentally-appropriate guidelines • Flexi hours attending to Adolescents e.g. holidays and on Weekends – e.g. Ndhiwa DH and Magina H/C • Strengthening human resource competencies for adolescent services e.g. APOC • Support for task-shifting • Scaling up viral load point of care (POC) testing for adolescents and actions towards attaining viral suppression • VIP treatment for Adolescents (Red Carpet); Integrating HIV care in youth friendly SRH services including FP &GBV
- 10. Intensified support for pregnant HIV Positive Adolescents • Enhanced adolescent friendly ANC including mobilization & ensuring attendance up to 4th ANC • Intensified follow-up and adherence counseling for HIV-infected pregnant adolescents • Adolescent-focused support groups, classes, and mentor mother programs for pregnant HIV+VE adolescents • Strengthening HCW capacity on the specialized needs of pregnant adolescents with talking points for discussing HIV and SRH issues in an adolescent-friendly manner • Sensitization and engagement of the men, family & CHVs to support pregnant ALHIV
- 11. Structural Interventions • Decentralize services of the HIV Tribunal • Dissemination of policies • Link adolescents to income-generating activities, micro credit and conditional cash transfer programs • Empower adolescents to know their rights and access comprehensive medical, legal, and social support services • Support for sites to set up adolescent-friendly corners • Review and update of privacy and confidentiality guidelines for cross-sector use
- 12. Stigma reduction Initiatives • ALHIV trained as champions against adolescents stigma • Social media campaigns, TV& radio programmes hosted by young champions on HIV & stigma and discrimination • Opinion leaders & celebrities to provide platforms to address stigma • Utilize social events including music& drama festivals to promote dialogue on adolescent HIV & stigma reduction • Strengthen Health clubs & support networks of teachers living with HIV to assist with health clubs to reduce stigma • Integration of HIV messages in school books & materials
- 13. The EGPAF Pamoja Homabay Project Response Adolescents (County & Sub-county HFs) • # of sites supported by program=89 • # of sites implementing MoH adolescent check list = 89 (100%) • # of sites implementing adolescent package of services = 89(100%) • # of sites with adolescent support groups = 58(65%) • # of HFs with adolescent specific clinic days = 48(54%) • # of HFs with referral and linkages to other non-clinical services = 89 (100%)
- 14. For 10 – 19 years Annual Target Semi Annual Achievement % Achieved Identification Total Tested 39,901 43,586 109% HIV Positive 962 535 56% Enrolment New Care 505 94% of the HIV+ Current Care 2,783 3,038 109% Access to ART New on ART 245 49% Current on ART 2,459 2,674 109%
- 15. Puzzle: What is the right mix? EBIs Social/Mass media Structural Interventions Bio-medical Interventions
Editor's Notes
- Strategy 3 Priority Activities: Adolescent mapping exercises to describe ALHIV and general adolescent gathering venues to improve access to HTC services Adolescent-specific activities during community events. Examples could include conducting adolescent dialogues during Child or Family Health Days or specifically focusing on adolescent issues during global or national campaigns (World AIDS Day, Youth Day, etc.). Implementation of adolescent-focused facility and community based events/activities. Examples include hosting Adolescent Health Days, mobile HIV testing at youth venues, and school-based activities such as health dialogues or HIV/SRH education sessions. Support for sites to set up and hold adolescent-friendly corners and/or adolescent-friendly clinic days with enhanced HIV and SRH counseling and services, flexible hours, and greater assurances of confidentiality and 5 Cs. Development and scale-up of HCW SOPs, training curricula, and talking points on adolescent-friendly services with ongoing support through supportive supervision, mentorship, and coaching activities and HCW cross-site learning approaches, including visits to model adolescent-friendly sites, cross-site mentorship, and other educational opportunities. Development of district, national, and potentially global ALHIV advisory groups. These advisory groups could provide guidance to facilities, district health authorities, or even EGPAF staff about current ALHIV challenges as well as suggestions for improving health services and/or activities. Exploration of opportunities to test new approaches for reaching adolescents, such as self-testing and enhanced point of care testing.
- Strategy 3 Priority Activities: Adolescent mapping exercises to describe ALHIV and general adolescent gathering venues to improve access to HTC services Adolescent-specific activities during community events. Examples could include conducting adolescent dialogues during Child or Family Health Days or specifically focusing on adolescent issues during global or national campaigns (World AIDS Day, Youth Day, etc.). Implementation of adolescent-focused facility and community based events/activities. Examples include hosting Adolescent Health Days, mobile HIV testing at youth venues, and school-based activities such as health dialogues or HIV/SRH education sessions. Support for sites to set up and hold adolescent-friendly corners and/or adolescent-friendly clinic days with enhanced HIV and SRH counseling and services, flexible hours, and greater assurances of confidentiality and 5 Cs. Development and scale-up of HCW SOPs, training curricula, and talking points on adolescent-friendly services with ongoing support through supportive supervision, mentorship, and coaching activities and HCW cross-site learning approaches, including visits to model adolescent-friendly sites, cross-site mentorship, and other educational opportunities. Development of district, national, and potentially global ALHIV advisory groups. These advisory groups could provide guidance to facilities, district health authorities, or even EGPAF staff about current ALHIV challenges as well as suggestions for improving health services and/or activities. Exploration of opportunities to test new approaches for reaching adolescents, such as self-testing and enhanced point of care testing.
- Strategy 1 Priority Activities: Enhanced PSS support groups (Ariel clubs/camps) with age- and developmentally-appropriate curricula including disclosure support, life skills, SRH education and services, and positive prevention. Transition to adult care support through standard operating procedures (SOPs), targeted counseling, escorts to adult ART clinics, intensified follow-up, and greater bi-directional linkages between pediatric and adult care and treatment providers/programs. Where possible, programs should track patient outcomes to determine the success of transition process. Dedicated retention and adherence support including strengthened adherence counseling, intensified follow-up, enhanced PSS support and caregiver education, development of patient materials and HCW job aids, and exploration of incentive strategies and social media/mHealth platforms. Engagement of ALHIV through country and potentially global-level forums or advisory groups to support the design and implementation of adolescent-focused clinical and support services. Support for transition to adult care through standard operating procedures (SOPs), targeted counseling, escorts to adult ART clinics, intensified follow-up, and greater bi-directional linkages between pediatric and adult care and treatment providers/programs. Where possible, programs should track patient outcomes to determine the success of transition process. Provision of disclosure support for caregivers and adolescents including age- and developmentally-appropriate curricula and materials, and to provide enhanced training for HCWs and peer educators (PEs) on disclosure of HIV status: support for disclosure of HIV status to perinatally infected ALHIV and for disclosure of HIV status by ALHIV to their family, friends, and sexual partners. Strengthening human resource competencies for adolescent needs including training HCWs and where possible, implementing task-shifting, to develop a trained cadre of lay counselors and adolescent or youth peer educators who can provide adolescent-friendly counseling, lead support groups, and assist with transition to adult care.
- Strategy 1 Priority Activities: Enhanced PSS support groups (Ariel clubs/camps) with age- and developmentally-appropriate curricula including disclosure support, life skills, SRH education and services, and positive prevention. Transition to adult care support through standard operating procedures (SOPs), targeted counseling, escorts to adult ART clinics, intensified follow-up, and greater bi-directional linkages between pediatric and adult care and treatment providers/programs. Where possible, programs should track patient outcomes to determine the success of transition process. Dedicated retention and adherence support including strengthened adherence counseling, intensified follow-up, enhanced PSS support and caregiver education, development of patient materials and HCW job aids, and exploration of incentive strategies and social media/mHealth platforms. Engagement of ALHIV through country and potentially global-level forums or advisory groups to support the design and implementation of adolescent-focused clinical and support services. Support for transition to adult care through standard operating procedures (SOPs), targeted counseling, escorts to adult ART clinics, intensified follow-up, and greater bi-directional linkages between pediatric and adult care and treatment providers/programs. Where possible, programs should track patient outcomes to determine the success of transition process. Provision of disclosure support for caregivers and adolescents including age- and developmentally-appropriate curricula and materials, and to provide enhanced training for HCWs and peer educators (PEs) on disclosure of HIV status: support for disclosure of HIV status to perinatally infected ALHIV and for disclosure of HIV status by ALHIV to their family, friends, and sexual partners. Strengthening human resource competencies for adolescent needs including training HCWs and where possible, implementing task-shifting, to develop a trained cadre of lay counselors and adolescent or youth peer educators who can provide adolescent-friendly counseling, lead support groups, and assist with transition to adult care.
- Strategy 2 Priority Activities: Intensified follow-up and adherence counseling for pregnant ALHIV on ART, particularly within first week after HIV diagnosis and ART initiation, postpartum, and during the first 6-week EID testing period. When possible, this support should include home visits for partner/family HIV testing and community engagement activities. Provision of the adolescent-focused support groups, classes, and mentor mother programs for HIV-infected pregnant girls. HIV-infected PSS groups and/or classes should include disclosure support, retention and adherence counseling, partner and family outreach, safe delivery and infant feeding, positive prevention, SRH/FP services and education, parenting skills, gender equity/female empowerment messaging, GBV prevention, and nutrition education and services. Strengthening HCW capacity on the specialized needs of pregnant adolescents with talking points for discussing HIV and SRH issues in an adolescent-friendly manner with consideration for the 5Cs for HTC. Enhanced HIV prevention and SRH/FP counseling and education for uninfected pregnant adolescents. Where possible, this should include safe delivery and infant feeding, parenting skills, gender equity/female empowerment messaging, GBV prevention, and nutrition education and services.
- Strategy 2 Priority Activities: Intensified follow-up and adherence counseling for pregnant ALHIV on ART, particularly within first week after HIV diagnosis and ART initiation, postpartum, and during the first 6-week EID testing period. When possible, this support should include home visits for partner/family HIV testing and community engagement activities. Provision of the adolescent-focused support groups, classes, and mentor mother programs for HIV-infected pregnant girls. HIV-infected PSS groups and/or classes should include disclosure support, retention and adherence counseling, partner and family outreach, safe delivery and infant feeding, positive prevention, SRH/FP services and education, parenting skills, gender equity/female empowerment messaging, GBV prevention, and nutrition education and services. Strengthening HCW capacity on the specialized needs of pregnant adolescents with talking points for discussing HIV and SRH issues in an adolescent-friendly manner with consideration for the 5Cs for HTC. Enhanced HIV prevention and SRH/FP counseling and education for uninfected pregnant adolescents. Where possible, this should include safe delivery and infant feeding, parenting skills, gender equity/female empowerment messaging, GBV prevention, and nutrition education and services.