“FANMI”: A Promising Differentiated Model of HIV Care for Adolescents in Haiti

Reif, Lindsey K.; Rivera, Vanessa; Bertrand, Rachel; Belizaire, Marie Elmase; Joseph, Joseph-Marie B.; Louis, Bianca; Joseph, Bernadette; Anglade, Benedict; Seo, Grace; Sévère, Patrice; Rouzier, Vanessa; Pape, Jean William; Fitzgerald, Daniel W.; McNairy, Margaret L.

doi:10.1097/qai.0000000000002088

Cited by 11 publications

(26 citation statements)

References 14 publications

(18 reference statements)

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“…Self-reported adherence was found to be associated with Kids Club participation, measured in total number of meetings attended and participation in 2018, suggesting a possible dose-response effect. Among Kids Club members with a recent viral load test, 64% were virally suppressed—a proportion somewhat higher than that reported in the FANMI study (i.e., 55% post intervention) [ 27 ] and a study at six Haitian hospitals that reported 50% virologic suppression among 13–21 year-olds [ 31 ]. In addition, a recent national cohort analysis of those initiated on ART in 2016 and 2017 found 45% virologic suppression among 10–14-year-olds in both cohorts and 50 and 87% among 15–19 year-olds in the 2016 and 2017 cohorts, respectively [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Age and sex composition was comparable to those targeted by other recently studied support interventions for young people, although some were more narrowly focused [ 20 ]. FANMI, a combination program approach implemented at Haiti’s largest HIV treatment clinic and piloted among ages 10–20 reported higher female than male participation (i.e., 76% female) and a median participant age of 17.5 years [ 27 ]. A study currently is underway testing the efficacy of FANMI among adolescent girls and young women ages 16–23 [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Support groups have emerged as a feasible strategy, and evidence of their impact on the health and well-being of children, adolescents, and youth is growing [ 15 – 20 ]. Several approaches have been explored, including those singularly focused on promoting ART adherence [ 21 , 22 ], as well as inclusion of a group intervention as part of a range of broader child- and youth-friendly, comprehensive, differentiated care packages of services [ 23 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti

Settergren

Robert

Louis

et al. 2021

BMC Health Serv Res

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Background Although access to antiretroviral therapy (ART) among children and young people living with HIV has increased in recent years, adherence to medication and viral suppression remain challenges. Evidence of benefits of support groups is growing and reflects a range of models and approaches. Since 2014, hospital-linked psychosocial support groups for children and young people living with HIV, known as Kids Clubs, have been established throughout Haiti. The program provides safe spaces for them to meet with peers, supports medication adherence, delivers health and life skills education, and facilitates linkages with clinic visits and social services. This study describes program enrollment and participant engagement, ART adherence and viral suppression among participants, and other outcomes attributed to the program by participants, caregivers, and program implementers. Methods Our mixed methods study included quantitative analysis of program monitoring data on rollout and attendance, and medication adherence and viral load results extracted from medical records. We collected qualitative data from club members, caregivers, and implementers about their experiences with the clubs and the impact of participation. Results From January 2014–December 2018, 1330 individuals aged 8–29 were enrolled in the program; over three-quarters participated for at least 12 months. In 2018, 1038 members attended at least one club meeting; more than half missed three or fewer monthly meetings. Three-quarters of ever-enrolled members reported consistent medication use at their most recent clinic visit; 64.2% (600/935) of those with a recent viral load test were virally suppressed. Level of club attendance was positively associated with ART adherence (p < 0.01) and viral suppression (p < 0.05). Club members, caregivers, and implementers noted the value of the clubs to participants’ retention in care and medication adherence, health knowledge, and capacity to deal with peer pressure, stigma, shyness, and depression. Conclusions The Kids Club program has been successful in scaling HIV support services to highly vulnerable children and young people through peer-based groups, and program participation has led to a range of benefits. Efforts to innovate, evaluate, and scale support strategies for vulnerable young populations must be accelerated in order to ensure that they survive, thrive, and reach their full potential.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti

Settergren

Robert

Louis

et al. 2021

BMC Health Serv Res

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“…We based our sample size estimate on a retrospective review of retention from the electronic medical record for the standard care arm and data from a cohort care pilot project for the FANMI arm [32]. We estimate that 85% of participants in the FANMI arm will be alive and retained in care at 12 months, compared to 60% of participants in the standard arm.…”

Section: Methodsmentioning

confidence: 99%

“…With a sample size of 160, we will have > 80% power to detect a 30% difference between the number of participants achieving a viral level < 1000 copies/ml between the two arms. We estimate that 60% of participants in FANMI and 30% of participants in standard care will achieve viral suppression based on pilot data [32].…”

Section: Methodsmentioning

confidence: 99%

The FANMI (“my FAMILY” in Creole) study to evaluate community-based cohort care for adolescent and young women living with HIV in Haiti: protocol for a randomized controlled trial

et al. 2019

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BackgroundAdolescent girls and young women living with HIV in resource-limited settings have the poorest health outcomes of any age group, due in part to poor retention in care. Differentiated models of HIV care that target the specific challenges of young people living with HIV are urgently needed.MethodsThe FANMI study is an unblinded randomized controlled trial designed to evaluate the efficacy of an adolescent-specific model of HIV care in Port-au-Prince, Haiti. The FANMI intervention places newly young women living with HIV who are not currently on ART or on ART ≤ 3 months, in cohorts of 5–10 peers to receive monthly group HIV care in a community location. In contrast, participants in the standard care arm receive routine HIV care and individual counseling each month in GHESKIO’s Adolescent Clinic. A total of 160 participants ages 16–23 years old are being randomized on a 1:1 basis. The primary outcome is retention in HIV care defined as being alive and in care at 12 months after enrollment. Secondary outcomes include viral suppression at 12 months, sexual risk behaviors, acceptability of the FANMI intervention, and health care utilization and costs.DiscussionThe FANMI study evaluates a novel community-based cohort model of HIV care aimed at improving retention in care and reducing risk behaviors for HIV transmission among adolescent girls and young women living with HIV. Specifically, the FANMI model of care addresses social isolation by placing participants in cohorts of 5–10 peers to provide intensified peer support and makes HIV health management a group norm; reduces stigma and improves convenience by providing care in a community setting; and integrates clinical care and social support by the same providers to streamline care and promote long-term patient-provider relationships. If shown to be effective, the FANMI intervention may serve as a model of HIV care for improving retention among hard-to-reach adolescents and young adults in Haiti and could be adapted for other high-risk groups globally.Trial registrationIdentifier: NCT03286504, Registered September 18, 2017.

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Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Bernays

Tshuma

Willis³

et al. 2020

J Intern AIDS Soc

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Introduction Low rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale. The provision of peer support has generated considerable enthusiasm because it has the potential to ameliorate the complex social and relational challenges which underpin suboptimal adherence. Little is known about the impact on young peer supporters themselves, which is the focus of this paper. Methods We present qualitative findings from the Zvandiri trial investigating the impact of a peer support intervention on the viral load for beneficiaries (ALHIV, aged 13 to 19 years) in Zimbabwe. The Zvandiri peer supporters aged 18 to 24 years, known as community adolescent treatment supporters (CATS), are themselves living with HIV. Individual in‐depth interviews were conducted in late 2018 with 17 CATS exploring their experiences of delivering peer support and their own support needs. Interviews were analysed iteratively using thematic analysis. Results The CATS reported that being peer supporters improved their own adherence behaviour and contributed to an improved sense of self‐worth. The social connections between the CATS were a source of comfort and enabled them to develop skills to manage the challenging aspects of their work. Two substantial challenges were identified. First, their work may reveal their HIV status. Second, managing the emotional labour of this caring work; given how commonly the complexity of the beneficiaries’ needs mirrored the circumstances of their own difficult lives. Both challenges were ameliorated by the support the CATS provided to each other and ongoing supervision from the adult mentor. There was variation in whether they felt their roles were appropriately valued through the remuneration they received and within the health system. There was a consensus that their experience meant that they would graduate from being a CATS with transferable skills that could enhance their employability. Conclusions Their experiences illustrate the advantages and opportunities of being a CATS. To minimize potential harms, it is vital to ensure that they feel valued in their role, which can be demonstrated by the provision of appropriate remuneration, recognition and respect, and that there is continued investment in ongoing support through ongoing training and mentoring.

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“FANMI”: A Promising Differentiated Model of HIV Care for Adolescents in Haiti

Cited by 11 publications

References 14 publications

Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti

Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti

The FANMI (“my FAMILY” in Creole) study to evaluate community-based cohort care for adolescent and young women living with HIV in Haiti: protocol for a randomized controlled trial

Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

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