Access and Retention to Treatment for Adolescents Living with HIV

By: Elizabeth Okoth – Program Manager

Outline

• Background

• Guiding Principles

• Intensive Case Finding Towards enhancing Access

• Strategic Interventions for Enhancing Adolescents Retention

• Case of EGPAF PAMOJA Homa Bay Project

2

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

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

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

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

LinkageImprove 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 flowSupport use of referral tools

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

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

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

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

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

The EGPAF Pamoja Homabay Project ResponseAdolescents (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%)

For 10 – 19 yearsAnnual Target

Semi Annual Achievement

% Achieved

IdentificationTotal Tested 39,901 43,586 109%HIV Positive 962 535 56%EnrolmentNew Care 505 94% of the HIV+

Current Care 2,783 3,038 109%

Access to ARTNew on ART 245 49%

Current on ART 2,459 2,674 109%

Puzzle: What is the right mix?

EBIsSocial/Mass media

Structural Interventions

Bio-medical Interventions

Thank You. Acknowledgment: Adolescents, Communities,

MOH, PEPFAR, CIFF ELMA, EJAF & ViiV HC