Title

Operation triple zero (OTZ): Implementation of an asset-based approach to improve viral load suppression among adolescents and young persons in Kenya, 2017-2021

Presenter

Immaculate Mutisya

Authors

I. Mutisya¹, A. Waruru¹, R. Ondondo¹, L. Omoto¹, S. Hrapcak², D. Carpenter², J. Gross², S. Njuguna¹, O. Muhenje¹, E. Ngugi¹, A. Katana¹, L. Ng'ang'a¹

Institutions

¹U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and Tuberculosis, Nairobi, Kenya, ²U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and Tuberculosis, Atlanta, United States

BACKGROUND: According to the Kenya Population-based HIV Impact Assessment (KENPHIA) 2018, only 70.6% of the 99,860 adolescents and young people living with HIV (AYPLHIV) were aware of their status, and among these, 93.1% were on treatment, and 79.2% had achieved viral load suppression (VLS). Asset-based models focus on adolescent strengths and promote an intrinsic desire to achieve good health outcomes among AYPLHIV. Operation Triple Zero (OTZ) is anchored on this principle and encourages adolescents to achieve zero missed appointments, zero missed medication, and to attain zero viral load (VL). We describe results of viral suppression, adherence and retention among AYPLHIV 10-24 yrs enrolled in OTZ, 2017-2021.
METHODS: Data were abstracted from OTZ registers at 20 health facilities. We analysed baseline and endline VL, re-suppression and sustained suppression rates. We tested for the independence of proportions for categorical variables using Pearson’s Chi-square test and compared characteristics at baseline (enrolment to the OTZ program) to the end-line using the McNemar Chi-square test.
RESULTS: Of the 1569 AYPLHIV enrolled in OTZ at the 20 early adopter sites, 1372 (84.4%) had complete records of age, sex, OTZ enrolment dates, and follow-up viral load results. Of these, 53.1% were females. The median age was 15.9 years [interquartile range,10-20 years]. Overall VLS improved from a baseline of 72.7% to 88.5% (p < 0.001. Retention in care was 94% compared to baseline of 63%. AYPLHIV in OTZ reporting satisfactory adherence had higher VLS (93%) than those with non-satisfactory adherence (68%), p<0.001.
Of the 958 AYPLHIV who were virally suppressed at baseline, 92.4% (885) sustained viral suppression through 2021. Sustained suppression was comparable between females and males (91.9% and 92.9%, respectively). AYPLHIV on once-a-day dosing of Dolutegravir (DTG) or Atazanavir (ATV/r) had 100% sustained suppression. Of the 282 viremic AYPLHIV at baseline, the re-suppression rate was 78.3%. AYPLHIV on Lopinavir and those reporting satisfactory adherence had a higher re-suppression rate of 82% and 87%, respectively.
CONCLUSIONS: Implementing the asset-based OTZ program improved adherence, retention, and viral load suppression among AYPLHIV at early-adopter sites. This strategy has a potential of accelerating progress towards achieving and sustaining of epidemic control for AYPLHIV.

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