Integrated service delivery, providing coordinated services in a convenient manner, is important in HIV prevention and treatment for adolescents as they have interconnected health care needs related to HIV care, sexual and reproductive health and disease prevention. This review aimed to (1) identify key components of adolescent-responsive integrated service delivery in low and middle-income countries, (2) describe projects that have implemented integrated models of HIV care for adolescents, and (3) develop action steps to support the implementation of sustainable integrated models. We developed an implementation science-informed conceptual framework for integrated delivery of HIV care to adolescents and applied the framework to summarize key data elements in ten studies or programs across seven countries. Key pillars of the framework included (1) the socioecological perspective, (2) community and health care system linkages, and (3) components of adolescent-focused care. The conceptual framework and action steps outlined can catalyze design, implementation, and optimization of HIV care for adolescents.

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Postnatal prophylaxis continues to play an essential role in efforts to eliminate new pediatric HIV infections and maximize HIV-free survival.n New approaches to postnatal prophylaxis using currently available modern oral antiretroviral drugs could surmount many current barriers. n Long-acting agents and delivery platforms currently in development for treating people living with HIV have great potential as postnatal prophylaxis for infants. n Studies of novel postnatal prophylactic agents are possible and imperative in the near future and must be prioritized early in the antiretroviral drug development pipeline.n Close collaboration between researchers, community representatives, industry, regulators, and policymakers will be the critical ingredient to ensure HIV-free survival for all infants with HIV exposure.

Introduction Children and adolescents (0-19 years) living with HIV (CALHIV) in Uganda have historically had lower viral load suppression (VLS) rates than adults and this was partly attributed to sub-optimal antiretroviral therapy (ART) regimens. By June 2019, less than 50% of CALHIV were on optimal regimens despite appropriate policies in place. In July 2019, Ministry of Health (MOH) embarked on an ART optimization campaign to put all CALHIV on optimal regimens. We describe the process, challenges, and achievements during June 2019 – March 2021. Methods The campaign started in July 2019 and ART optimization was phased by age and by region due to ART stock shortage and gradually spread to the entire country with realization of sufficient stock. ART optimization referred to initiating or transitioning CALHIV on either an integrase strand transfer inhibitor(dolutegravir) or a protease inhibitor (Boosted lopinavir) as the anchor drug. Implementation of the campaign involved building capacity for ART optimization for all stakeholders and weekly use of robust data to monitor progress and make timely interventions along with regular supervision and onsite mentorships. MOH developed indicators on optimization which the implementing partners reported at weekly meetings facilitated by the MOH. A data call was made at end of March 2021 to determine the progress on ART optimization of CALHIV in Uganda and VLS analysis was done to assess the early impact of ART optimization. Results Adolescents comprised the majority (40,931/ 64,723; 63.2%) of CALHIV in HIV care by March 2021. Almost all (63,053/64,723; 97.4%) of CALHIV had been transitioned to optimal ART regimens. Despite the successful ART optimization for CALHIV, viral load suppression increased just slightly and remained suboptimal (<95%) by March 2021. Conclusions Proper preparation and timely data use for decision making enabled Uganda to succeed at ART optimization for almost all CALHIV amidst the COVID19 pandemic. However, ART optimization alone was not sufficient to have optimal viral load suppression nationally.

Background Retention in care and HIV viral load suppression remains sub-optimal among HIV positive adolescents in many settings including TASO Uganda, despite the implementation of interventions such as regimen optimization and community-based approaches like multi-month drug dispensing. To this end, the implementation of additional intervention is urgently required to address gaps in current programming which include inadequate centralization of the HIV positive adolescents and their caregivers in the designs. This study, thus, proposes to adapt and implement the Operation Triple Zero (OTZ) model in TASO Soroti and Mbale centers to improve both retention and viral load suppression among the adolescents living with HIV. Methodology A before and after study design is preferred, employing both qualitative and quantitative approaches. To identify barriers and facilitators to retention and HIV viral load suppression among the HIV positive adolescents, secondary data, focused group discussions, and key informant interviews will be used to understand perspectives of the adolescents, their caregivers, and the health-workers. The Consolidated Framework for Implementation Research (CFIR) will help in designing the intervention, while Knowledge to Action (K2A) will support the adaptation process. To test the intervention, Reach, Effectiveness, Adaption, Implementation and Maintenance (RE-AIM) framework will be used. A paired t-test will be used to compare means of retention and viral load suppression in the before and after study periods. Discussion This study aims at adapting and implementing the OTZ model in TASO Soroti and Mbale Centers of Excellence (COEs) to attain optimal retention and HIV viral load suppression rates among the HIV positive adolescents in care. Uganda is yet to adapt the touted OTZ model and findings from this study will be important in providing the necessary lessons to inform a policy shift for potential scale up of the model. Furthermore, results of this study could provide additional evidence for the effectiveness of OTZ in attaining optimal HIV treatment outcomes among the adolescents living with HIV.