Abstract
BackgroundYouth-led strategies remain untested in clinic-based programs to improve viral suppression (VS) and reduce stigma among HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. In response, Project YES! placed paid HIV-positive youth peer mentors (YPM) in four HIV clinics in Ndola, Zambia including a Children’s Hospital (pediatric setting), an adult Hospital and two primary care facilities (adult settings).MethodsA randomized controlled trial was conducted from December 2017 to February 2019. Consecutively recruited 15 to 24-year-olds were randomly assigned to an intervention arm with monthly YPM one-on-one and group sessions and optional caregiver support groups, or a usual care comparison arm. Survey data and blood samples were collected at baseline and at the six-month midline. Generalized estimating equation models evaluated the effect of study arm over time on VS, antiretroviral treatment (ART) adherence gap, and internalized stigma.ResultsOut of 276 randomized youth, 273 were included in the analysis (Intervention n = 137, Comparison n = 136). VS significantly improved in both arms (I:63.5% to 73.0%; C:63.7% to 71.3.0%) [OR:1.49, 95% CI:1.08, 2.07]. In a stratified analysis intervention (I:37.5% to 70.5%) versus the comparison (C:60.3% to 59.4%) participants from the pediatric clinic experienced a relative increase in the odds of VS by a factor of 4.7 [interaction term OR:4.66, 95% CI:1.84, 11.78]. There was no evidence of a study arm difference in VS among AYA in adult clinics, or in ART adherence gaps across clinics. Internalized stigma significantly reduced by a factor of 0.39 [interaction term OR:0.39, 95% CI:0.21,0.73] in the intervention (50.4% to 25.4%) relative to the comparison arm (45.2% to 39.7%)ConclusionsProject YES! engaged AYA, improving VS in the pediatric clinic and internalized stigma in the pediatric and adult clinics. Further research is needed to understand the intersection of VS and internalized stigma among AYA attending adult HIV clinics.Trial registrationClinicalTrials.gov NCT04115813.
Highlights
Adolescents and young adults (AYA) living with HIV access HIV care less and have lower rates of adherence to antiretroviral therapy (ART) and viral suppression (VS) compared to adults [1,2,3,4,5,6,7]
The contents of this paper are the sole responsibility of the authors and do not necessarily reflect the views of President’s Emergency Plan for AIDS Relief (PEPFAR), United States Agency for International Development (USAID), or the United States Government
This research has been facilitated by the infrastructure and resources provided by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR
Summary
Adolescents and young adults (AYA) living with HIV access HIV care less and have lower rates of adherence to antiretroviral therapy (ART) and viral suppression (VS) compared to adults [1,2,3,4,5,6,7]. Despite our knowledge of the needs of transitioning adolescents drawn from other chronic illnesses, as well as the impact families and peers have on AYA health [18,19,20], there is little published literature on interventions to support HIV-positive youth and their families in SSA [21]. A 2015 review found only 14 studies on HIV-positive adolescents transitioning to adult care, all of which were conducted in the US or UK and the majority of which were qualitative studies with sample sizes of 50 participants or fewer [22]. A 2016 systematic review examined the literature to assess the effectiveness of self-management interventions for young people across chronic illnesses. Project YES! placed paid HIV-positive youth peer mentors (YPM) in four HIV clinics in Ndola, Zambia including a Children’s Hospital (pediatric setting), an adult Hospital and two primary care facilities (adult settings)
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