Zimbabwe MoH Experience in Adolescent HIV Care. Dr HT Bara HIV Program Manager Harare City Health Department

Transcription

1 Zimbabwe MoH Experience in Adolescent HIV Care Dr HT Bara HIV Program Manager Harare City Health Department

2 Conflict of Interest None

3 Introduction Zimbabwe is among the high HIV burden countries in SSA 1.3m PLWHIV, 7% are children HIV prevalence 13.8% in adults yrs (16.7% females, 10.5% in males) Generalised epidemic characterised mainly by unprotected heterosexual transmission Prevalence higher in key populations than in the general population

4 Estimated HIV Prevalence in children and adults, male female 0-14

5 Prevalence & Number of Adolescents (10-19yrs) LHIV in Zimbabwe, by sex Source: 2016 HIV Estimates Report In 2017, there were 61,351 adolescents living with HIV in Zimbabwe with 57.7% being female Adolescents constituted 4.7% of total PLHIV and contributed 14.2% (5,770) of new HIV Infections While female adolescents are more than their male counterparts, the estimated number who are HIV positive is on the decline while that of men continues to increase albeit at a slow rate.

6 Evolution of HIV Care service provision Zimbabwe started offering HIV cares services in the public sector in pilot sites Roll out to other sites Public health approach Simplification of processes testing, treatment, monitoring Standardisation Equity accessibility, affordability, acceptability Decentralisation

7 HIV services have significantly been decentralised since program inception which has brought services closer to those who need them. Health facilities offering HIV Services March 2018

8 Where do we currently stand?

9 Progress in meeting targets for adolescents & young women However, men and young people still experience lower level of testing: 42% of women and only 26% of men had tested in the last 12 months in Zimbabwe Nearly half of young people (15-24 years) living with HIV in Zimbabwe do not know their status

10 Young People s Progress towards the ART Coverage Source: ZIMPHIA

11 Key Achievements at June 2018 Results/Progress Adolescent ART Coverage, Zimbabwe, March 2018, Progress: RED (<25%); ORANGE (25-50%); GREEN (>50%) Indicators 2018 Target Progress Mar 2018 ART coverage among children <10 years old 90% 86% ART coverage among adolescents years old Retention on ART at 12 months post initiation children <10 years old Retention on ART 12 months post initiation adolescents years old 95% 91.7% > 90% 90.7% > 90% 88.6% 11

12 ART adherence by age group HIV Nutrition study in PLHIV enrolled in ART care Takarinda K et al. BMC Nutrition (2017) 3:15 ART adherence* Age group (in years) (N = 1,242) yrs 20+yrs %(95% CI) %(95% CI) 95% 89.5( ) 92.8( ) <95% 10.5( ) 7.2( ) Established through abstraction from routine records & based on pill counts or self reports by patients. 31 health facilities selected by PPS sampling from 235 ART high volume out of 1,646 public health facilities.

13 Retention rates (%) Overall ART Retention Rates, , ,6 88,6 88,1 87,2 84,6 86,6 85,2 81, months 24 months 36 months Peadiatrics <10yrs Adolescents 10-19yrs Non-pregnant adults 20+ yrs Source: Draft epms report, 2018

14 VL suppression rate (%) VL suppression rates for the first VL test stratified by age group among patients enrolled in ART care, ,2 66,4 81,4 83,2 84,9 86,9 <10 yrs yrs yrs yrs yrs 50+ yrs Age group

15 Missed opportunities prevalent in National Care & Treatment Cascade for Children and Adolescents, Jan - Mar 2018 Children HIV Care and Treatment Cascade, Jan Mar 2018 Adolescents HIV Care and Treatment Cascade, Jan Mar 2018

16 Differentiated Service Delivery for Adolescents

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18 Stable Adolescents

19 Key adolescent challenges to consider when scaling up Health services access geographic, economic, HCW attitude Legal framework consent, assent Stigma and discrimination Disclosure Adherence Retention in care Viral suppression Relationships

20 MoH Innovations to address key challenges Health services access Decentralisation Adolescent friendly services Free HIV services Disclosure issues Assisted disclosure Expert patients / peer counsellors Adherence / viral suppressions Adherence supporters, CATS Support groups More friendly ART formulations Efavirenz 400, FDCs

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23 MoH Innovations to address key challenges Retention in care As for adherence Reduced refill visits Relationships Support groups Age of consent? Policy review Lobby for harmonisation of the constitution and the Act Other use of evidence from research to inform programming and scale up

24 Partner support in implementation and scale up Global Fund NAC CHAI UNICEF OPHID PSI Africaid PATA Pangaea EGPAF FHI360 ITECH

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27 Lessons learnt Involvement of expert patients in adolescent HIV care improves their health seeking behavior and uptake of services Adolescents take up services better when health education is given in a way that they identify with including the use of celebrities Scale up of adolescent HIV care services requires a significant amount of partner support

28 Challenges Human resources Manual data management system Occasional disruptions in the supply chain management system High mobility and incorrect contact details

29 Conclusion Adolescent HIV care requires innovative strategies in order to identify, treat and retain them in care Adherence and retention are still low among adolescents and young people More innovative strategies to address these are still required

30 Thank You