Community intervention improves knowledge of HIV status of adolescents in Zambia

Kwame Shanaube,Richard Hayes,Mwate Joseph Chaila,Constance Mackworth-Young,Graeme Hoddinott,Sian Floyd,Ab Schaap,Helen Ayles,Sarah Fidler

doi:10.1097/qad.0000000000001530

Abstract

Objective:To determine the uptake of home-based HIV counselling and testing (HCT) in four communities of the HPTN 071 (PopART) trial in Zambia among adolescents aged 15–19 years and explore factors associated with HCT uptake.Design:The PopART for youth study is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa which aims to evaluate the acceptability and uptake of a HIV prevention package, including universal HIV testing and treatment, among young people. The study is nested within the HPTN 071 (PopART) trial.Methods:Using a door-to-door approach that includes systematically revisiting households, all adolescents enumerated were offered participation in the intervention and verbal consent was obtained. Data were analysed from October 2015 to September 2016.Results:Among 15 456 enumerated adolescents, 11 175 (72.3%) accepted the intervention. HCT uptake was 80.6% (8707/10 809) and was similar by sex. Adolescents that knew their HIV-positive status increased almost three-fold, from 75 to 210. Following visits from community HIV care providers, knowledge of HIV status increased from 27.6% (3007/10 884) to 88.5% (9636/10 884). HCT uptake was associated with community, age, duration since previous HIV test; other household members accepting HCT, having an HIV-positive household member, circumcision, and being symptomatic for STIs.Conclusion:Through a home-based approach of offering a combination HIV prevention package, the proportion of adolescents who knew their HIV status increased from ∼28 to 89% among those that accepted the intervention. Delivering a community-level door-to-door combination, HIV prevention package is acceptable to many adolescents and can be effective if done in combination with targeted testing.

Highlights

AIDS is the leading cause of death among adolescents in Sub-Sahara Africa (SSA), and the second most common cause of death among adolescents globally [1]
We report results and explore factors associated with HCTuptake by adolescents aged 15–19 years in four arm A communities in Zambia who are offered a ‘full’ combination HIV prevention package that includes universal HIV testing and treatment (UTT) through a door-to-door approach from the P-antiretroviral therapy (ART)-Y study
Adolescents’ HIV status knowledge Shanaube et al S227 association for Sexually transmitted infections (STI) symptomatic females in multivariable analysis

Summary

Introduction

AIDS is the leading cause of death among adolescents in Sub-Sahara Africa (SSA), and the second most common cause of death among adolescents globally [1]. An estimated 2.1 million adolescents aged 10–19 years are living with HIV globally [2], the majority of these in SSA, including 79 000 in Zambia [2,3,4]. More than 250 000 adolescents aged 15–19 year old were newly infected with HIV in 2013, with girls accounting for two out of three of these new infections globally and eight out of 10 in SSA [1]. The vast majority of adolescents in Africa, including those already infected with HIV, do not know their HIV status [5,6]. Antiretroviral therapy (ART) has dramatically improved survival for people living with HIV, clinical outcomes of HIV-positive adolescents fall behind adults, a consequence of poor knowledge of status and lack of access to therapy [4]

Methods

Results

Discussion

Conclusion