Post on 06-Apr-2017
transcript
Access and Retention to Treatment for Adolescents Living with HIV
By: Elizabeth Okoth – Program Manager
Outline
• Background
• Guiding Principles
• Intensive Case Finding Towards enhancing Access
• Strategic Interventions for Enhancing Adolescents Retention
• Case of EGPAF PAMOJA Homa Bay Project
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Back Ground – The Kenya Situation
• 29% of all new HIV infections in Kenya are among adolescents & youth• About 16% of PLHIV in Kenya are adolescents & youth• Young women (15 –24yrs) contribute 21% of all new infections• HIV-positive adolescent girls face a much higher risk of poor maternal
& infant outcomes& increased risks for MTCT• AIDS-related deaths is the leading cause of death among adolescents
in Kenya (9,720 died in 2014)• Only 23.5% of adolescents aged 15-19 years know their HIV status• Low disclosure, poor adherence & stigma among adolescents• Benefit of early treatment with an overall 75% decline in mortality
&ART with viral suppression reduces risk of sexual transmission of HIV
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Guiding Principles to Increasing Access & Retention
• Recognition of heterogeneity of adolescents and their needs
• Building and using of evidence base & best practices to inform interventions
• Combination approach to addressing adolescents needs & Strengthening referrals to other social/protective services
• Adolescent engagement in advocacy, design and implementation of services and policy directions
• “National Adolescent Package of Care as SOP”
• Commitment through strategy and policy
Intensified HIV case-finding for adolescents LHIV
• Screen all adolescents that present at facility & provide PITC
• Test all adolescents in inpatient, TB, nutrition and STI clinics, pregnant adolescents, married & adolescents with children
• Scale up family- centred model to test and treat adolescents with HIV-infected parents & OVC
• Universal testing in epidemic hotspots to increase coverage
• Piloting and evaluating new approaches such as self-testing
• SRH approaches that combined STI and HIV screening and partner testing services in adolescent friendly manner
• Engaging HTS Counsellors to focus on adolescents
Use of EBIs in Enhancing Identification
• Evidence-informed Behavioral Interventions (EBIs) are interventions that have been rigorously evaluated and have been shown to have significant efficacy
• EBIs that target adolescents such as SHUGA, Sister to Sister and RESPECT-K have strong HTS component
• SHUGA: A mass multimedia behavior change communication initiative targeting youth ages 15 to 24 with HIV prevention messages and linking them to vital services
• Sister to Sister: Individual level risk reduction intervention for sexually active women with focus on self efficacy, safer sex negotiation skills, & encourages HTS
LinkageImprove linkage and ensure enrolment of at least 90% of HIV-infected adolescents on HIV care“Everything stops” until the adolescent is linked (enrolled)Recruit and deploy linkage staff / Peer Educators (including adolescent peer educators)Strengthen facility linkage teams and client flowSupport use of referral tools
Enhancing Adolescents Retention to Treatment
• Engagement of adolescents through facility, County & Country forums to support the design and implementation of adolescent-focused clinical and support services
• Graduated disclosure support for HIV-infected adolescents
• Enhanced adherence support including treatment literacy and engagement of caregivers
• Strategies for transitioning to adolescents care & treatment and from adolescents to adult care and treatment
• Enhancing mHealth and social media platforms to send appointment reminders and strengthen the client-facility feedback loop
Enhancing Adolescents Retention to Treatment• Adolescents psychosocial support groups with age and
developmentally-appropriate guidelines
• Flexi hours attending to Adolescents e.g. holidays and on Weekends – e.g. Ndhiwa DH and Magina H/C
• Strengthening human resource competencies for adolescent services e.g. APOC
• Support for task-shifting
• Scaling up viral load point of care (POC) testing for adolescents and actions towards attaining viral suppression
• VIP treatment for Adolescents (Red Carpet); Integrating HIV care in youth friendly SRH services including FP &GBV
Intensified support for pregnant HIV Positive Adolescents
• Enhanced adolescent friendly ANC including mobilization & ensuring attendance up to 4th ANC
• Intensified follow-up and adherence counseling for HIV-infected pregnant adolescents
• Adolescent-focused support groups, classes, and mentor mother programs for pregnant HIV+VE adolescents
• Strengthening HCW capacity on the specialized needs of pregnant adolescents with talking points for discussing HIV and SRH issues in an adolescent-friendly manner
• Sensitization and engagement of the men, family & CHVs to support pregnant ALHIV
Structural Interventions
• Decentralize services of the HIV Tribunal
• Dissemination of policies
• Link adolescents to income-generating activities, micro credit and conditional cash transfer programs
• Empower adolescents to know their rights and access comprehensive medical, legal, and social support services
• Support for sites to set up adolescent-friendly corners
• Review and update of privacy and confidentiality guidelines for cross-sector use
Stigma reduction Initiatives
• ALHIV trained as champions against adolescents stigma
• Social media campaigns, TV& radio programmes hosted by young champions on HIV & stigma and discrimination
• Opinion leaders & celebrities to provide platforms to address stigma
• Utilize social events including music& drama festivals to promote dialogue on adolescent HIV & stigma reduction
• Strengthen Health clubs & support networks of teachers living with HIV to assist with health clubs to reduce stigma
• Integration of HIV messages in school books & materials
The EGPAF Pamoja Homabay Project ResponseAdolescents (County & Sub-county HFs)
# of sites supported by program=89
# of sites implementing MoH adolescent check list = 89 (100%)
# of sites implementing adolescent package of services = 89(100%)
# of sites with adolescent support groups = 58(65%)
# of HFs with adolescent specific clinic days = 48(54%)
# of HFs with referral and linkages to other non-clinical services = 89 (100%)
For 10 – 19 yearsAnnual Target
Semi Annual Achievement
% Achieved
IdentificationTotal Tested 39,901 43,586 109%HIV Positive 962 535 56%EnrolmentNew Care 505 94% of the HIV+
Current Care 2,783 3,038 109%
Access to ARTNew on ART 245 49%
Current on ART 2,459 2,674 109%
Puzzle: What is the right mix?
EBIsSocial/Mass media
Structural Interventions
Bio-medical Interventions
Thank You. Acknowledgment: Adolescents, Communities,
MOH, PEPFAR, CIFF ELMA, EJAF & ViiV HC