Abstract
Background Adolescents living with HIV (ALHIV) are challenged to adhere to antiretroviral therapy (ART) and achieve and maintain virologic suppression. Group-based adherence support interventions, such as adherence clubs, have been shown to improve long-term adherence in ART patients. The teen club intervention was introduced in 2010 in Namibia to improve treatment outcomes for ALHIV by providing adherence support in a peer-group environment. Adolescents who have completed the full HIV disclosure process can voluntarily join the teen clubs. The current study compared treatment outcomes of ALHIV receiving ART at a specialized paediatric HIV clinic between 1 July 2015 and 30 June 2017 in Windhoek, Namibia. Methods A retrospective cohort analysis was conducted on routine patient data extracted from the electronic Patient Monitoring System, individual Patient Care Booklets, and teen club attendance registers. A sample of 385 adolescents were analysed: 78 in teen clubs and 307 in standard care. Virologic suppression was determined at 6, 12, and 18 months from study start date, and compared by model of care, age, sex, disclosure status, and ART regimen. Comparisons between adolescents in teen clubs and those receiving standard care were performed using the chi-square test, and risk ratios were calculated to analyze differences in ART adherence and virologic suppression. Results The average clinician-measured ART adherence was 89% good, 6% fair, and 5% poor amongst all adolescents, with no difference between teen club members and adolescents in standard care (p = 0.277) at 3 months. Virologic suppression over the 2-year observation period was 87% (68% fully suppressed <40 copies/ml and 19% suppressed between 40–999 copies/ml), with no difference between teen club members and those in standard care. However, there were statistically significant differences in virologic suppression levels between the younger (10–14 years) adolescents and older (15–19 years) adolescents at 6 months (p = 0.015) and at 12 months (p = 0.021) and between adolescents on first-line and second-line ART regimen at 6 months (p = 0.012), 12 months (p = 0.004), and 18 months (p = 0.005). Conclusion The teen club model delivering psychosocial support only did not improve adherence and virologic suppression levels for adolescents in a specialized paediatric ART clinic, neither were they inferior to standard care. Considering the limitations of this study, teen clubs may still hold potential for improving adherence and virologic suppression levels for older adolescents, and more robust research on adherence interventions for adolescents with higher methodological quality is required.
Highlights
Due to the successes in prevention of mother-to-child transmission (PMTCT) programs worldwide and advances in paediatric HIV treatment, children with HIV are surviving to reach adolescence [1]. e World Health Organization defines adolescents as children or young adults between 10 and 19 years of age [2]
A retrospective cohort study was conducted using medical records of HIV positive adolescents between ages of 10 and 19 years receiving antiretroviral therapy (ART) at a hospital-based paediatric HIV clinic in Windhoek, Namibia. e paediatric ART clinic is a specialized HIV clinic with dedicated staff for paediatric HIV management, which includes a physician, nurses, counsellors, and other support staff. e study population was stratified into two groups of adolescents attending the teen club and adolescents who were receiving standard care
Records of adolescents who were transferred in from other facilities, who had incorrectly entered demographic information, and who are with missing files/Patient Care Booklets (PCBs) were excluded from the final study sample
Summary
Due to the successes in prevention of mother-to-child transmission (PMTCT) programs worldwide and advances in paediatric HIV treatment, children with HIV are surviving to reach adolescence [1]. e World Health Organization defines adolescents as children or young adults between 10 and 19 years of age [2]. In 2010, teen club interventions were introduced at health facilities in Malawi to provide ALHIV on ART with dedicated clinic time, peer mentorship, sexual and reproductive health education, ART refill and support for positive living, and treatment adherence. ALHIV aged 15–19 years were more likely to have attrition from care than those aged 10–14 years (aOR 2.14; 95% CI 1.12, 4.11) [16] Another evaluation in Malawi of a similar teen club intervention reported in 2019 on adherence levels between younger and older adolescents and male and female adolescents found that older adolescence were associated with higher odds of optimal adherence compared to younger adolescents (aOR 1.48; 95% CI 1.16–1.90, p < 0.01) [17]. Is paper reports on the effects of the teen club intervention against standard care on ART adherence and virologic suppression amongst adolescents at the clinic.
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