Effects of a Peer-Led Intervention on HIV Care Continuum Outcomes Among Contacts of Children, Adolescents, and Young Adults Living With HIV in Zimbabwe

Talent Tapera, Nicola Willis, Kudakwashe Madzeke, Tanyaradzwa Napei, Mather Mawodzeke, Stanley Chamoko, Abigail Mutsinze, Teddy Zvirawa, Beatrice Dupwa, Aveneni Mangombe, Anesu Chimwaza, Talent M Makoni, Winnie Mandewo, Mbazi Senkoro, Philip Owiti, Jaya Prasad Tripathy, Ajay M V Kumar, Talent Tapera, Nicola Willis, Kudakwashe Madzeke, Tanyaradzwa Napei, Mather Mawodzeke, Stanley Chamoko, Abigail Mutsinze, Teddy Zvirawa, Beatrice Dupwa, Aveneni Mangombe, Anesu Chimwaza, Talent M Makoni, Winnie Mandewo, Mbazi Senkoro, Philip Owiti, Jaya Prasad Tripathy, Ajay M V Kumar

Abstract

Background: Africaid Zvandiri, in partnership with the Ministry of Health and Child Care (MOHCC) in Zimbabwe, implemented a comprehensive, peer-led program, focused on children, adolescents, and young adults living with HIV aged 0-24 years. The peers, known as community adolescent treatment supporters (CATS), are people living with HIV (PLHIV) aged 18-24 years who are trained and mentored to support their peers throughout the HIV care continuum through support groups, home visits, phone call reminders, and messages. We report the HIV care continuum outcomes (HIV testing uptake, antiretroviral therapy [ART] uptake, retention, and viral suppression) in a cohort of household contacts and sexual partners (aged younger than 25 years) of index children, adolescents, and young adults living with HIV identified by CATS from October 2017 to September 2018 in 24 districts of Zimbabwe.

Methods: This was a retrospective cohort study involving analysis of routine program data, extracted from electronic databases consisting of data on contacts of index PLHIV and ART outcomes. We used April 30, 2019, as the censor date for all analyses.

Results: A total of 15,223 household contacts and sexual partners with unknown HIV status (linked to 9,353 index PLHIV) were identified and referred for HIV testing. Of these, 12,114 (79.6%) were tested and 1,193 (9.8%) were HIV-positive. Of the latter, 1,153 (96.6%) were initiated on ART with 99% starting on the day of diagnosis. Of those on ART, 1,151 (99.8%) were alive on ART at 6 months and 2 (0.2%) died. A total of 1,044 (91%) children, adolescents, and young people living with HIV underwent viral load testing at 6 months or later, of whom 1,037 (99.3%) were virally suppressed (<1000 copies/ml).

Conclusion: These findings add to the global evidence demonstrating the effectiveness of peer-led interventions in children, adolescents, and young adults living with HIV and justify the decision of the MOHCC in Zimbabwe to scale-up the model nationally. Future research should aim to understand the reasons for the gaps in HIV testing and viral load testing using qualitative research.

© Tapera et al.

Figures

FIGURE 1.
FIGURE 1.
The Zvandiri Model of Care Involving the Community Adolescent Treatment Supporters in Zimbabwe Abbreviations: ART, antiretroviral therapy; CATS, community adolescent treatment supporters; HTS, HIV testing services; PLHIV, people living with HIV; PMTCT, prevention of mother-to-child transmission of HIV; PSS, psychosocial support; SRHR, sexual and reproductive health and rights; SMS, short message service; TB, tuberculosis.

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global HIV & AIDS Statistics - 2018 fact sheet. UNAIDS website . Published 2018 Accessed August 9, 2018.
    1. Ssewanyana D, Mwangala PN, van Baar A, Newton CR, Abubakar A. Health risk behaviour among adolescents living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. BioMed Res Int. 2018;2018:7375831. 10.1155/2018/7375831.
    1. Toska E, Pantelic M, Meinck F, Keck K, Haghighat R, Cluver L. Sex in the shadow of HIV: a systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. PLoS One. 2017;12(6):e0178106. 10.1371/journal.pone.017810.
    1. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global Report UNAIDS Report on the Global AIDS Epidemic 2013. . Accessed August 9, 2018.
    1. Nachega JB, Hislop M, Nguyen H, et al. . Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa. J Acquir Immune Defic Syndr. 2009;51(1):65–71. 10.1097/QAI.0b013e318199072e.
    1. Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care. 2015;27(7):805–816. 10.1080/09540121.2015.1011073.
    1. Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS. 2014;28(13):1945–1956. 10.1097/QAD.0000000000000316.
    1. Adejumo OA, Malee KM, Ryscavage P, Hunter SJ, Taiwo BO. Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review. J Int AIDS Soc. 2015;18(1):20049. 10.7448/IAS.18.1.20049.
    1. Bobat R, Archary M, Lawler M. An update on the HIV treatment cascade in children and adolescents. Curr Opin HIV AIDS. 2015;10(6):411–419. 10.1097/COH.0000000000000201.
    1. Govindasamy D, Ferrand RA, Wilmore SMS, et al. . Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2015;18(1):20182. 10.7448/IAS.18.1.20182.
    1. Callahan T, Modi S, Swanson J, Ng’eno B, Broyles LN. Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go. J Int AIDS Soc. 2017;20(1):21858. 10.7448/IAS.20.1.21858.
    1. World Health Organization (WHO). HIV and Adolescents: Guidance for HIV Testing and Counselling and Care for Adolescents Living with HIV. Geneva, Switzerland: WHO; 2013.
    1. Kilewo C, Massawe A, Lyamuya E, et al. . HIV counseling and testing of pregnant women in sub-Saharan Africa: experiences from a study on prevention of mother-to-child HIV-1 transmission in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr. 2001;28(5):458–462. 10.1097/00042560-200112150-00009.
    1. Ministry of Health and Child Care (MOHCC). Zimbabwe Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2015-16: First Report. Harare, Zimbabwe: MOHCC; 2017. . Accessed August 9, 2018.
    1. Willis N, Napei T, Armstrong A, et al. . Zvandiri—bringing a differentiated service delivery program to scale for children, adolescents, and young people in Zimbabwe. J Acquir Immune Defic Syndr. 2018;78(Suppl 2):S115–S123. 10.1097/QAI.0000000000001737.
    1. World Health Organization (WHO). Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach, 2nd ed. Geneva, Switzerland:WHO; 2016. .
    1. AIDS and TB Programme, Ministry of Health and Child Care (MOHCC). Operational and Service Delivery Manual for the Prevention, Care and Treatment of HIV in Zimbabwe. Harare, Zimbabwe: MOHCC; 2017. .
    1. Siril HN, Kaaya SF, Smith Fawzi MK, et al. . CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study. AIDS Res Ther. 2017;14(1):18. 10.1186/s12981-017-0145-z.
    1. Eba PM, Lim H. Reviewing independent access to HIV testing, counselling and treatment for adolescents in HIV-specific laws in sub-Saharan Africa: implications for the HIV response. J Int AIDS Soc. 2017;20(1):21456. 10.7448/IAS.20.1.21456.
    1. Mavhu W, Willis N, Mufuka J, et al. . Evaluating a multi-component, community-based program to improve adherence and retention in care among adolescents living with HIV in Zimbabwe: study protocol for a cluster randomized controlled trial. Trials. 2017;18(1):478. 10.1186/s13063-017-2198-7.

Source: PubMed

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