Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenario
Abstract Background In Malawi, compared to adults, adolescents have higher rates of high HIV viremia and poorer antiretroviral therapy (ART) outcomes. The Ministry of Health, supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), implemented the provision of differentiated care clubs f...
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2024-12-01
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| Series: | BMC Public Health |
| Online Access: | https://doi.org/10.1186/s12889-024-21109-0 |
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| author | Rachel Chamanga Tessa Musukwa Louiser Kalitera Felix Gent Harrid Nkhoma Kwashie Kudiabor Alice Maida Dumbani Kayira Verita Buie Godfrey Woelk Thulani Maphosa |
| author_facet | Rachel Chamanga Tessa Musukwa Louiser Kalitera Felix Gent Harrid Nkhoma Kwashie Kudiabor Alice Maida Dumbani Kayira Verita Buie Godfrey Woelk Thulani Maphosa |
| author_sort | Rachel Chamanga |
| collection | DOAJ |
| description | Abstract Background In Malawi, compared to adults, adolescents have higher rates of high HIV viremia and poorer antiretroviral therapy (ART) outcomes. The Ministry of Health, supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), implemented the provision of differentiated care clubs for adolescents living with HIV (ALHIV), called “teen clubs,” to provide psychosocial support and an HIV care package to improve clinical outcomes. We evaluated teen club attendance and factors associated with unsuppressed viral load (VL) in ALHIV enrolled in these teen clubs. Methods This cross-sectional study used program data from 35 health facilities in four districts that offered teen club services. We enrolled all ALHIV receiving ART ages 10–19 years who attended teen clubs between July 2018- September 2019 and had documented viral load results. Unsuppressed VL was defined as HIV RNA = > 1000 copies/mL, and optimal ART adherence was defined as having an expected pill count suggesting that between 95 and 105% of pills prescribed were consumed. We used multivariable logistic regression to identify factors associated with unsuppressed VL, adjusting for sex, age, education, district, adherence assessment, disclosure of one’s HIV status, and teen club attendance. Results Our analysis included 1,162 ALHIV with a median age of 15 years (IQR 13–17). The majority were female (n = 614, 53%) and attended one or two teen club visits (n = 665, 57%). Unsuppressed VL was identified in 28% of ALHIV. ALHIV with sub-optimal ART adherence were twice as likely to have unsuppressed VL (adjusted odds ratio [aOR] 2.0, 95% confidence interval (CI): 1.42–2.62) compared to those with optimal ART adherence. ALHIV on second-line treatments, were nearly four times more likely to have unsuppressed VL (aOR 3.7, 95% CI: 1.64–9.09) compared with those on first-line ART. ALHIV who had attained secondary school education were less likely to have unsuppressed VL (aOR 0.42, 95% CI 0.21–0.81) than those who only attained primary school education. Conclusion Even amongst adolescents enrolled in teen clubs, teen club attendance is low and high HIV viremia prevails. A continual focus on adolescents is needed to promote consistent teen club attendance and consistent ART adherence among the adolescents enrolled in differentiated service delivery. |
| format | Article |
| id | doaj-art-3f9f5f067068462b8942c0d865925633 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-3f9f5f067068462b8942c0d8659256332025-01-05T12:49:20ZengBMCBMC Public Health1471-24582024-12-012411910.1186/s12889-024-21109-0Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenarioRachel Chamanga0Tessa Musukwa1Louiser Kalitera2Felix Gent3Harrid Nkhoma4Kwashie Kudiabor5Alice Maida6Dumbani Kayira7Verita Buie8Godfrey Woelk9Thulani Maphosa10 Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)Division of Public Health Service and Implementation Science, U.S. Centers for Disease Control and Prevention (CDC)Division of Public Health Service and Implementation Science, U.S. Centers for Disease Control and Prevention (CDC)Division of Public Health Service and Implementation Science, U.S. Centers for Disease Control and Prevention (CDC) Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)Abstract Background In Malawi, compared to adults, adolescents have higher rates of high HIV viremia and poorer antiretroviral therapy (ART) outcomes. The Ministry of Health, supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), implemented the provision of differentiated care clubs for adolescents living with HIV (ALHIV), called “teen clubs,” to provide psychosocial support and an HIV care package to improve clinical outcomes. We evaluated teen club attendance and factors associated with unsuppressed viral load (VL) in ALHIV enrolled in these teen clubs. Methods This cross-sectional study used program data from 35 health facilities in four districts that offered teen club services. We enrolled all ALHIV receiving ART ages 10–19 years who attended teen clubs between July 2018- September 2019 and had documented viral load results. Unsuppressed VL was defined as HIV RNA = > 1000 copies/mL, and optimal ART adherence was defined as having an expected pill count suggesting that between 95 and 105% of pills prescribed were consumed. We used multivariable logistic regression to identify factors associated with unsuppressed VL, adjusting for sex, age, education, district, adherence assessment, disclosure of one’s HIV status, and teen club attendance. Results Our analysis included 1,162 ALHIV with a median age of 15 years (IQR 13–17). The majority were female (n = 614, 53%) and attended one or two teen club visits (n = 665, 57%). Unsuppressed VL was identified in 28% of ALHIV. ALHIV with sub-optimal ART adherence were twice as likely to have unsuppressed VL (adjusted odds ratio [aOR] 2.0, 95% confidence interval (CI): 1.42–2.62) compared to those with optimal ART adherence. ALHIV on second-line treatments, were nearly four times more likely to have unsuppressed VL (aOR 3.7, 95% CI: 1.64–9.09) compared with those on first-line ART. ALHIV who had attained secondary school education were less likely to have unsuppressed VL (aOR 0.42, 95% CI 0.21–0.81) than those who only attained primary school education. Conclusion Even amongst adolescents enrolled in teen clubs, teen club attendance is low and high HIV viremia prevails. A continual focus on adolescents is needed to promote consistent teen club attendance and consistent ART adherence among the adolescents enrolled in differentiated service delivery.https://doi.org/10.1186/s12889-024-21109-0 |
| spellingShingle | Rachel Chamanga Tessa Musukwa Louiser Kalitera Felix Gent Harrid Nkhoma Kwashie Kudiabor Alice Maida Dumbani Kayira Verita Buie Godfrey Woelk Thulani Maphosa Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenario BMC Public Health |
| title | Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenario |
| title_full | Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenario |
| title_fullStr | Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenario |
| title_full_unstemmed | Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenario |
| title_short | Examining teen club attendance and viral load suppression among adolescents under differentiated HIV care in Malawi: a sub-optimal scenario |
| title_sort | examining teen club attendance and viral load suppression among adolescents under differentiated hiv care in malawi a sub optimal scenario |
| url | https://doi.org/10.1186/s12889-024-21109-0 |
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