Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and <scp>HIV</scp> care

MacPherson, Peter; Munthali, Chigomezgo; Ferguson, Jane; Armstrong, Alice; Kranzer, Katharina; Ferrand, Rashida A; Ross, David A.

doi:10.1111/tmi.12517

Cited by 155 publications

(198 citation statements)

References 75 publications

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“…This comes out of increasing advocacy by adolescents themselves and recognition by service providers and programmes of the developmental differences between adolescents, children and adults and how these differences impact on the adolescent HIV disease course, treatment requirements and engagement with HIV services [3]. The strength of the recommendations made in the recent guideline revision is affected by a lack of specific evidence on optimal drug regimens and service delivery approaches for adolescents [51]. The process of recognizing that adolescents may require different recommendations to adults or children has highlighted the numerous gaps in the evidence for what the most appropriate and effective ART regimens are for this age group.…”

Section: Who Art Guideline Revisions – the Need For Adolescent‐specifmentioning

confidence: 99%

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Slogrove

Mahy

Armstrong

et al. 2017

Journal of the International AIDS Society

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121

101

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Introduction: With increasing survival of vertically HIV‐infected children and ongoing new horizontal HIV infections, the population of adolescents (age 10–19 years) living with HIV is increasing. This review aims to describe the epidemiology of the adolescent HIV epidemic and the ability of national monitoring systems to measure outcomes in HIV‐infected adolescents through the adolescent transition to adulthood.Methods: Differences in global trends between younger (age 10–14 years) and older (age 15–19 years) adolescents in key epidemic indicators are interrogated using 2016 UNAIDS estimates. National population‐based survey data in the 15 highest adolescent HIV burden countries are evaluated and examples of national case‐based surveillance systems described. Finally, we consider the potential impact of adolescent‐specific recommendations in the 2016 WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.Discussion: UNAIDS estimates indicate the population of adolescents living with HIV is increasing, new HIV infections in older adolescents are declining, and while AIDS‐related deaths are beginning to decline in younger adolescents, they are still increasing in older adolescents. National population‐based surveys provide valuable estimates of HIV prevalence in older adolescents and recent surveys include data on younger adolescents. Only a few countries have nationwide electronic case‐based HIV surveillance, with the ability to provide population‐level data on key HIV outcomes in the diagnosed population living with HIV. However, in the 15 highest adolescent HIV burden countries, there are no systems tracking adolescent transition to adulthood or healthcare transition. The strength of the 2016 WHO adolescent‐specific recommendations on antiretroviral therapy and provision of HIV services to adolescents was hampered by the lack of evidence specific to this age group.Conclusions: Progress is being made in national surveillance and global monitoring systems to specifically identify trends in adolescents living with HIV. However, HIV programmes responsive to the evolving HIV prevention and treatment needs of adolescents can be facilitated further by: data disaggregation to younger and older adolescents and mode of HIV infection where feasible; implementation of tools to achieve expanded national case‐based surveillance; streamlining consent/assent procedures in younger adolescents and consensus on indicators of adolescent healthcare transition and transition to adulthood.

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Section: Who Art Guideline Revisions – the Need For Adolescent‐specifmentioning

confidence: 99%

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Slogrove

Mahy

Armstrong

et al. 2017

Journal of the International AIDS Society

Self Cite

121

101

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“…HTC can reduce risk behaviour in HIV-negative individuals, while providing a means to link them to primary prevention (including circumcision and pre-exposure prophylaxis (PrEP)) 18–21 . We evaluate effectiveness in reaching men and young adults (both groups have a disproportionately high risk of HIV acquisition and poorer clinical outcomes once infected 22–24 ) and targeted HTC for key populations (men who have sex with men (MSM), commercial sex workers (CSWs) and people who inject drugs (PWID)) — groups that generally have very high HIV prevalence and low access to health care 25 . We assess HIV positivity to characterize yield and examine CD4 count at diagnosis to identify modalities that have the potential to link infected persons to care earlier in their disease course.…”

mentioning

confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

451

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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“…Another systematic review included 11 studies from nine countries, including three randomised controlled trials of low methodological quality that assessed the effectiveness of interventions to improve adolescents' adherence to antiretroviral therapy 21. Five interventions were evaluated, including counselling and education; use of adherence support devices (e.g.…”

Section: What Is the Evidence For Adherence Interventions?mentioning

confidence: 99%

“…Five interventions were evaluated, including counselling and education; use of adherence support devices (e.g. medication boxes and beepers); financial incentives; peer support; and directly observed therapy 21. Two of the three RCTs showed some benefit from the interventions; however, conclusions were limited by the small numbers of participants 20…”

Section: What Is the Evidence For Adherence Interventions?mentioning

confidence: 99%

Can we improve adolescent adherence?

2016

DTB

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Adherence has been defined as the extent to which a person's action and behaviour matches the agreed recommendations from a clinician.(1,2) It is a continuous and dynamic process influenced by many factors, including the disease, the treatments, the healthcare team and system, social and economic factors, as well as patient-related factors.(1) Non-adherence may adversely affect clinical outcomes and lead to increased healthcare costs.(1-3) Reported rates of adherence are around 50% for people with long-term conditions, and may be as low as 30% among adolescents (aged 10-19 years).(1,3,4) Around 20% of those aged under 18 years have a chronic illness and treatment often requires long-term cumbersome regimens including multiple daily medicines, making adherence challenging.(1,3,5) It is important to distinguish between intentional and non-intentional adherence and to tailor interventions to the individual, using every healthcare contact as an opportunity to discuss adherence.(1) Here we consider the challenges faced by healthcare professionals in encouraging adolescents to adhere to treatment regimens (in particular taking medicines) and some strategies that may help.

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Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care

Cited by 155 publications

References 75 publications

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Can we improve adolescent adherence?

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