Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection:  A Review of Models and Actions for Implementation

Subramanian, Sujha; Namusoke-Magongo, Eleanor; Edwards, Patrick; Atujuna, Millicent; Chimulwa, Teddy; Dow, Dorothy; Jalil, Emilia Moreira; Torbunde, Nguavese; Agot, Kawango; Arinaitwe, Ivan Kabiita; Beizer, Jenny; Chelwa, Nachela; Mbalinda, Scovia Nalugo; Miti, Sam; Mwangwa, Florence

doi:10.1007/s10461-022-03787-2

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…These may include peer support groups, such as Operation Triple Zero and Zvandiri, digital health interventions such as WhatsApp and Facebook support groups, enhanced monitoring and counseling, back to treatment strategies, and comprehensive community-based support and services provided through orphans and vulnerable children programming, for those eligible. [30][31][32] In the future, it would be interesting to further analyze the differences in HIV treatment services access and uptake for younger adolescents vs older adolescents during subsequent waves of the COVID-19 pandemic, with a particular interest in identifying and understanding potential gaps in linkage to ART, VLC, and VLS.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on HIV Adolescent Programming in 16 Countries With USAID-Supported PEPFAR Programs

Okegbe¹,

Williams

Plourde

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction:The COVID-19 pandemic has disrupted access to critical health services, resulting in diminished gains in HIV epidemic control. This review assesses the magnitude of the impact that the COVID-19 pandemic has had on HIV services for adolescents.Methods:PEPFAR Monitoring, Evaluation, and Reporting programmatic data were analyzed from across 16 USAID-supported adolescent care and treatment programs for fiscal year 2020 (FY20; October 2019–September 2020). Descriptive statistics were used to calculate absolute number and percent change between the pre-COVID-19 (Quarters 1–2; October 2019–March 2020) and COVID-19 periods (Quarters 3–4; April 2020–September 2020) for clinical cascade indicators. All analyses were conducted in Microsoft Excel.Results:The number of HIV tests conducted during COVID-19 decreased by 21.4% compared with pre-COVID-19, with a subsequent 28% decrease in adolescents identified living with HIV. The rate of proxy linkage to antiretroviral therapy increased between periods, from 86.9% to 90.4%. There was a 25.9% decrease in treatment initiations among adolescents during COVID-19. During FY20, viral load coverage rates for adolescents dropped from 81.6% in FY20Q1 to 76.5% in FY20Q4, whereas the rates of viral load suppression for adolescents increased from 76.1% in FY20Q1 to 80.5% in FY20Q4.Conclusion:There was a substantial decrease in case-finding, treatment initiations, and viral load coverage rates for adolescents supported in USAID/PEPFAR programs during the COVID-19 pandemic. Additional health systems adaptations and strategies are required to ensure adolescents have continued access to HIV services during pandemic disruptions.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on HIV Adolescent Programming in 16 Countries With USAID-Supported PEPFAR Programs

Okegbe¹,

Williams

Plourde

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Adolescent girls and young women (AGYW) in low-and middle-income countries (LMICs), experience challenges that impact their health and well-being, including HIV, poor sexual and reproductive health (SRH), and gender-based violence (GBV) (1)(2)(3)(4). Zambia is among the most affected countries in Africa (5). These public health concerns are interlinked in a complex cycle (5,6), perpetuated by poverty, gender inequality, and social marginalization (5,7).…”

Section: Introductionmentioning

confidence: 99%

“…Zambia is among the most affected countries in Africa (5). These public health concerns are interlinked in a complex cycle (5,6), perpetuated by poverty, gender inequality, and social marginalization (5,7). For instance, most HIV infections in the sub-Saharan region are associated with SRH-related issues such as pregnancy and sexually transmitted infections (5,7).…”

Section: Introductionmentioning

confidence: 99%

“…These public health concerns are interlinked in a complex cycle (5,6), perpetuated by poverty, gender inequality, and social marginalization (5,7). For instance, most HIV infections in the sub-Saharan region are associated with SRH-related issues such as pregnancy and sexually transmitted infections (5,7). Violence and the threat of violence can compound HIV or SRH problems by undermining AGYW's ability to negotiate equal decision-making within relationships, including safer sex practices (2,7,8).…”

Section: Introductionmentioning

confidence: 99%

“…Integrated service delivery is vital as it promotes satisfaction and potential gains in health outcomes by reducing the chance of missed opportunities through timely and convenient service delivery (2). Further, integration reduces HIV-related stigma and discrimination, duplication of activities, ine ciency of, and competition for scarce resources, thereby enhancing program effectiveness and e ciency (5,6,8,15). To promote acceptability and sustainability of the integrated strategies, it is important to consider community health systems (CHS) in the implementation process (2,7,14).…”

Section: Introductionmentioning

confidence: 99%

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Specifying implementation strategies used in delivering services for HIV, gender-based violence and sexual and reproductive health to adolescent girls and young women in community health systems in Zambia

Zulu,

Maritim,

Silumbwe

et al. 2024

Preprint

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Background Adolescent girls and young women (AGYW) in Zambia experience challenges including gender-based violence (GBV) and difficulty obtaining care for sexual and reproductive health (SRH) and treatment for HIV. Implementation strategies for delivering GBV, SRH and HIV services targeted to AGYW in community health systems (CHS) have not been fully specified. We sought to define and specify common implementation strategies being used in Zambia. Methods In a qualitative case study in 3 districts, we interviewed 29 key informants from government bodies, NGOs, and community leaders; we also conducted 23 in-depth interviews with AGYW aged between 10 and 24 years. Analysis of the data used thematic analysis based on the four CHS lenses (programmatic, relational, collective action, and critical lenses) and on the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies. Results Implementation strategies identified under the programmatic lens were 1) changing infrastructure, which included increasing health facilities and delivering adolescent- and young people-friendly services; 2) training and educating stakeholders, which consisted of increasing capacity building, developing and using educational materials, ongoing training and educational outreach visits; and 3) adapting and tailoring services to context, which included delivering integrated services and developing by-laws. Relational lens strategies were 1) developing stakeholder interrelationships such as building a coalition of service providers; and 2) using new funding through cost-sharing among stakeholders. Under the collective action lens, implementers mainly engaged consumers, by increasing demand using community networks, using mass media to share information, and intervening with patients to enhance uptake of services. The critical lens showed that effective implementation of GBV, SRH and HIV services was affected by structural and socio- cultural factors such as social stigma and cultural norms. Conclusion This study builds on the ERIC compilation of implementation strategies by identifying and specifying implementation strategies used in the delivery of HIV, GBV and services for AGYW in community health systems. We provide additional evidence on the importance of relational and collective-action approaches in strengthening community-engaged implementation and dissemination.

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Implementation Science for Eliminating HIV Among Adolescents in High-Burden African Countries: Findings and Lessons Learned from the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA)

et al. 2023

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Eliminating adolescent HIV in high-burden African countries depends on the success of implementing evidence-based interventions to reduce transmission and improve treatment outcomes. The Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) takes a collaborative approach to addressing key challenges and identifying and developing new areas of investigation to advance the adolescent HIV agenda. This special supplement represents the collective learning of the Alliance related to implementation science in the context of the adolescent HIV continuum of care from multiple African countries. Specifically, this series describes the current academic landscape of adolescent HIV and implementation science, such as the methodological use and utility of implementation measures and frameworks; addresses timely topics such as the use of innovative technologies for study adaptations in the context of the global COVID-19 pandemic; and explores opportunities to enhance adolescent-responsive approaches to HIV prevention and treatment using implementation science.

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Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection: A Review of Models and Actions for Implementation

Cited by 5 publications

References 15 publications

Impact of COVID-19 on HIV Adolescent Programming in 16 Countries With USAID-Supported PEPFAR Programs

Impact of COVID-19 on HIV Adolescent Programming in 16 Countries With USAID-Supported PEPFAR Programs

Specifying implementation strategies used in delivering services for HIV, gender-based violence and sexual and reproductive health to adolescent girls and young women in community health systems in Zambia

Implementation Science for Eliminating HIV Among Adolescents in High-Burden African Countries: Findings and Lessons Learned from the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA)

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