Impact of Youth and Adolescent Friendly Services on Retention of 10–24-Year-Olds in HIV Care and Treatment Programs in Nyanza, Kenya

Teasdale, Chloe A; Alwar, Terezah; Chege, Duncan; Fayorsey, Ruby; Hawken, Mark; Abrams, Elaine J.

doi:10.1097/qai.0000000000000877

Cited by 42 publications

(55 citation statements)

References 9 publications

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“…Our results were similar to a study in Kenya, which reported that youth-friendly HIV services did not improve long-term retention [31]. In comparison to a study on retention among adults in HIV care at GHESKIO [32], a higher proportion of adolescents in our cohort were LTF at each step in the cascade.…”

Section: Discussionsupporting

confidence: 86%

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

Reif

Bertrand

Charles

et al. 2016

Journal of the International AIDS Society

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IntroductionAdolescents account for over 40% of new HIV infections in Haiti. This analysis compares outcomes among HIV-positive adolescents before and after implementation of an adolescent HIV clinic in Port-au-Prince, Haiti.MethodsWe conducted a cohort study using programmatic data among HIV-positive adolescents aged 13 to 19. Data from 41,218 adolescents who were HIV tested from January 2003 to December 2012 were included. Outcomes across the HIV care cascade were assessed before and after implementation of an adolescent clinic (2009), including HIV testing, enrolment in care, assessment for antiretroviral therapy (ART) eligibility, ART initiation and 12-month retention. Pre-ART outcomes were assessed 12 months after HIV testing. Factors associated with pre-ART and ART attrition were identified through multivariable competing risk and Cox proportional hazards regression modelling.ResultsCumulatively, 1672 (4.1%) adolescents tested HIV positive (80% female, median age 16 years). Retention by cascade step comparing pre- and post-clinic included the following: 86% versus 87% of patients enrolled in care, 61% versus 79% were assessed for ART eligibility, 85% versus 92% initiated ART and 68% versus 66% were retained 12 months after ART initiation. Pre-ART attrition decreased from 61% pre-clinic to 50% post-clinic (p<0.001). Pre-ART attrition was associated with being female (sub-distributional hazard ratio (sHR): 1.59; CI: 1.31–1.93), syphilis diagnosis (sHR: 1.47; CI: 1.16–1.85) and slum residence (sHR: 0.84; CI: 0.72–0.97). ART attrition was associated with syphilis diagnosis (hazard ratio (HR): 2.23; CI: 1.35–3.68) and CD4 <50 cells/µL (HR: 1.88; CI: 1.15–3.06).ConclusionsImplementation of a youth-friendly adolescent clinic improved retention in HIV care among adolescents, particularly in the assessment of ART eligibility and ART initiation. Additional interventions are needed to improve retention among pre-ART patients and support long-term retention among ART patients.

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Section: Discussionsupporting

confidence: 86%

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

Reif

Bertrand

Charles

et al. 2016

Journal of the International AIDS Society

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“…This is likely due to elimination of the “adult transition” step, which facilitates continued care and retention of adolescent records. While there is value in dedicated adolescent clinics , the transition period can prove a vulnerable point for LTFU . On the other hand, food support appeared to be a strong factor associated with reduction of LTFU among adults but not among adolescents (where integration of services was the main factor associated with reduced rates of LTFU).…”

Section: Discussionmentioning

confidence: 95%

Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART

et al. 2018

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IntroductionAdolescence and pregnancy are potential risk factors for loss to follow‐up (LTFU) while on antiretroviral therapy (ART). We compared adolescent and adult LTFU after ART initiation to quantify the impact of age, pregnancy, and site‐level factors on LTFU.MethodsWe used routine clinical data for patients initiating ART as young adolescents (YA; 10 to 14 years), older adolescents (OA; 15 to 19 years) and adults (≥20 years) from 2000 to 2014 at 52 health facilities affiliated with the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa collaboration. We estimated cumulative incidence (95% confidence interval, CI) of LTFU (no clinic visit for ≥6 months after ART initiation) and identified patient and site‐level correlates of LTFU, using multivariable Cox proportional hazards models for all patients as well as individual age groups.ResultsA total of 138,387 patients initiated ART, including 2496 YA, 2955 OA and 132,936 adults. Of these, 55%, 78% and 66%, respectively, were female and 0.7% of YA, 22.3% of OA and 8.3% of adults were pregnant at ART initiation. Cumulative incidence of LTFU at five years was 26.6% (24.6 to 28.6) among YA, 44.1% (41.8 to 46.3) among OA and 29.3% (29.1 to 29.6) among adults. Overall, compared to adults, the adjusted hazard ratio, aHR, (95% CI) of LTFU for OA was 1.54 (1.41 to 1.68) and 0.77 (0.69 to 0.86) for YA. Compared to males, pregnant females had higher hazard of LTFU, aHR 1.20 (1.14 to 1.27), and nonpregnant women had lower hazard aHR 0.90 (0.88 to 0.93). LTFU hazard among the OA was primarily driven by both pregnant and nonpregnant females, aHR 2.42 (1.98 to 2.95) and 1.51 (1.27 to 1.80), respectively, compared to men. The LTFU hazard ratio varied by IeDEA program. Site‐level factors associated with overall lower LTFU hazard included receiving care in tertiary versus primary‐care clinics aHR 0.61 (0.56 to 0.67), integrated adult and adolescent services and food ration provision aHR 0.93 (0.89 to 0.97) versus nonintegrated clinics with food ration provision, having patient support groups aHR 0.77 (0.66 to 0.90) and group adherence counselling aHR 0.61 (0.57 to 0.67).ConclusionsOlder adolescents experienced higher risk of LTFU compared to YA and adults. Interventions to prevent LTFU among older adolescents are critically needed, particularly for female and/or pregnant adolescents.

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“…Those with missing CD4 at ART initiation, CD4 >350 and those <100/mL had higher attrition compared with those initiating ART between 100 and 350 cells/mL.– enrolling into HIV care while on treatment for TB lower attrition in pre-ART phase (RR = 0, 60, 95%CI: 0, 48–0, 73) but no difference in attrition after ART initiation.– Kenya, Mozambique, Tanzania had higher pre-ART attrition compared with adolescents and young adults attending clinics in RwandaMSF report, 2011–2015, unpublished [26]Khayelitsha, Cape Town, South AfricaProspective cohort providing a youth differentiated model of care: with same day point of care CD4 testing and rapid ART initiation, without comparison group337 HIV-infected adolescents and young adults, 12–25 years, enrolled from 2012 to 2015MSF-funded youth clubs with psychosocial support, HIV clinical management, family planning, linkage to mentor via mobile phoneOverall 12-month retention outcome: 82% (95% CI: 76–86%).Varying significantly by enrolment category ( p < 0.001):

Ineligible to start ART: 53% (95% CI: 40–64%)

Newly initiated on ART: 86% (95% CI: 79–91%)

Stable on ART: 94% (95% CI: 85–97%)

Zanoni, (Int HIV ped W 2016) [48]KwaZulu-Natal, South AfricaRetrospective cohort comparing a Saturday teen clinic compared to standard weekday paediatric clinics254 perinatally HIV-infected adolescentsSaturday teen clinic was implemented was dedicated peer support and structured social activities after 6 months on ARTOverall viral suppression was 85% and retention 89%. Significantly higher retention rates in adolescents attending the dedicated teen clinic (97%) versus adolescents in standard care (85%) ( p = 0.0005)Teasdale, C.J.Aquir Immune Defic Syndr2016 [49]Nyanza, KenyaRetrospective analysis comparing LTFU pre-YAFS (youth- adolescent-friendly services) to LTFU post YAFS in 6 YAFS. In addition LTFU outcomes were examined in the pre (03–12/2011) and post YAFS periods (312/2013) at 28 health facilities that did not implement YAFS to examine changes in LTFU in the same periods which were unrelated to YAFS.The analysis examined LTFU before ART and LTFU after ART2321 HIV-infected adolescents and young adults 10–24 yearsICAP-funded YAFS with(1) training and mentorship for health care providers on care for adolescent/youth(2) one day per month at least about sexually and reproductive health, gynaecologic examination condoms, contraception (3) groups and education programmePre ART:– we observed decrease in LTFU between the pre- and post-YAFS but the difference was no significant p = 0.15– no difference in LTFU between YAFS and non-YAFS facilities in pre YAFS period ( p = 0.08) and no significant difference post ( p = 0.87) YAFS period.Post ART:– no significant difference in LTFU in the before and after YAFS p = 0.19– no significant difference in LTFU between YAFS and non-YAFS facilities in pre ( p = 0.73) or post ( p = 0.77) YAFS period– for health facilities that did not have YAFS, LTFU observed in the after period was significantly high...…”

Section: Adolescent and Youth Post-transition Outcomes In Sub-saharanmentioning

confidence: 99%

“…Further studies are needed to determine the factors that facilitate successful delivery of care for HIV-infected adolescents as they prepare to transition into adults care [48]. In a retrospective study comparing pre and post-ART retention before and after the implementation of youth-friendly services in Nyanza, Kenya, results suggest that offering a basic set of youth-friendly services, including dedicated clinics and support groups targeted to adolescents and youth, may not be adequate to surmount the retention barriers faced by adolescents and young adults [49]. Other factors such as socio-economic factors (food supplementation, schooling, employment and enhanced social support) or clinical (adherence) factors may also contribute to retention of this group and should be further understood [49].…”

Section: Adolescent and Youth Post-transition Outcomes In Sub-saharanmentioning

confidence: 99%

“…In a retrospective study comparing pre and post-ART retention before and after the implementation of youth-friendly services in Nyanza, Kenya, results suggest that offering a basic set of youth-friendly services, including dedicated clinics and support groups targeted to adolescents and youth, may not be adequate to surmount the retention barriers faced by adolescents and young adults [49]. Other factors such as socio-economic factors (food supplementation, schooling, employment and enhanced social support) or clinical (adherence) factors may also contribute to retention of this group and should be further understood [49]. There is a need to examine community-based approaches to reach and retain adolescents and youth to support treatment adherence, and to identify sub-groups that are at highest risk of dropping out for targeted care and support [50].…”

Section: Adolescent and Youth Post-transition Outcomes In Sub-saharanmentioning

confidence: 99%

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Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Dahourou

Gautier-Lafaye

Teasdale

et al. 2017

Journal of the International AIDS Society

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110

145

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Introduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition.Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10–24 years with information on transition were eligible.Results: Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older adults. There is a need to identify sub-groups at higher risk of loss to follow-up for targeted care and peer support.Expert commentary: Although the available HIV-related data on adolescent transition outcomes are limited, there is evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa.

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Impact of Youth and Adolescent Friendly Services on Retention of 10–24-Year-Olds in HIV Care and Treatment Programs in Nyanza, Kenya

Cited by 42 publications

References 9 publications

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

Adolescent pregnancy at antiretroviral therapy (ART) initiation: a critical barrier to retention on ART

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

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