Evaluation of nutritional conditions, haemoglobin levels, retention in care and viral suppression in a cohort of HIV-infected Malawian adolescents undergoing a one-year tailored intervention within the Diseases Relief through Excellence and Advanced Means

The United Nations Children’s Fund (UNICEF) reported that ~1 770 000 adolescents were living with HIV infection worldwide in 2018. [1] In the same year, 590 000 young patients aged 15 24 years became infected with HIV. [1] Moreover, in 2016, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that adolescents aged 10 19 years is the only age group in which deaths related to HIV infection are not reducing. [2] HIV infection in adolescents is one of the major challenges for health sectors in sub-Saharan Africa (SSA), as >80% of HIV-positive young patients aged 10 19 years live in this region. [3] The number of HIV-positive adolescents is expected to increase in the future mainly due to a combination of two factors: new infections in adolescents, and the widespread use of paediatric antiretroviral treatment (ART) that will result in HIV-positive children survive and age. Adherence to ART is still a global challenge,[4,5] especially in HIV-positive adolescents. [6] Although better outcomes have been reported in SSA than in Europe and North America,[7] attrition remains a challenge in HIV care programmes for adolescents in many countries in SSA. [8-10] Poor adherence is related to worse general outcomes and scarce control of viral replication. [11,12] This could have several consequences from a public health perspective: increasing transmission rates in the population, the circulation of resistant strains, and an increase in patients needing to switch to secondor third-line treatment. [13,14] There is an urgent need to design programmes that offer more effective interventions to reach a high number of HIV-positive adolescents. Malawi is one of the countries most severely affected by HIV, with a prevalence of 9.2% in people aged 15 49 years,[15] and where ~25 000 boys and 46 000 girls aged 10 19 years are infected with HIV[2] Although interventions that were intended to improve adherence have been widely evaluated,[16-18] evidence on the outcomes of specific adolescent-friendly interventions is scarce. [19] The present study aimed to evaluate a specific adolescent-friendly service implemented Background. The United Nations Children’s Fund (UNICEF) reported that ~1 770 000 adolescents were living with HIV infection in 2017, of whom >80% were in sub-Saharan Africa. In Malawi, ~25 000 boys and 46 000 girls are infected with HIV. Objective. The present study aimed to evaluate a specific adolescent-friendly service implemented in a Diseases Relief through Excellence and Advanced Means (DREAM) health centre in Malawi. Methods. All HIV-positive patients aged 10 19 years in the care of the DREAM centre in Blantyre on 17 December 2016 were included in the study and followed-up until 1 January 2018. The service was organised for one adult-free day, with some side activities managed by a co-ordinator and youth leaders. Assessments were performed at the end of the period (EOP). Results. On 17 December 2016, 425 patients were enrolled in the study. Follow-up status at EOP was 403 (94.8%) patients in care, 7 (1.6%) lost to follow-up (LTFU), 2 (0.5%) died and 13 (3.1%) were transferred to other facilities. Death and LTFU rates were 0.72/100 and 2.9/100 person-years, respectively. Moreover, 50.6% (n=198/391) of patients had an improvement in body mass index (BMI)-for-age z-scores, and 70.2% (n=33/47) of patients who were malnourished at baseline improved (higher improvement in older patients). Mean (standard deviation (SD)) haemoglobin levels increased from 12.5 (1.5) mg/dL to 13.1 (1.9) mg/dL (significance level p=0.000). At the EOP, 79.0% (n=309/391) of patients had viral suppression. Conclusion. Care of adolescent HIV+ patients remains a challenge, but the implementation of specific projects involving adolescents and youth leaders can increase adherence and improve viral suppression.