Title

Child/adolescent-centric differentiated care to enhance clinical care and viral load suppression among children and adolescents living with HIV, Andhra Pradesh, India 2022

Presenter

Melissa Nyendak

Authors

R. Agarwal¹, D. Shanta², N. Chava², P. Kumar², A. Rao², G. Ramesam², R. Prasad², P. Turaka², R. Allam¹, S. Verma¹, S. Upadhyaya¹, A.E. Florence³, V. Yeldandi², M. Nyendak¹, K. Prasad³

Institutions

¹U S Centers for Disease Control and Prevention, Division of Global HIV and TB, Delhi, India, ²Society for Health Allied Research & Education India, Hyderabad, India, ³Andhra Pradesh State AIDS Control Society, Vijayawada, India

BACKGROUND: Low rates of viral load suppression (VLS) among children and adolescents living with HIV (C/ALHIV) remains a challenge globally. Andhra Pradesh (AP; second highest HIV burden state, India) had a VLS rate of 65% (2754 of 4211) among C/ALHIV on antiretroviral therapy (ART) (Sept 2021). Secondary analysis of program data indicated sub-therapeutic (age/weight) dosage of ART due to lack of weight monitoring or proxy pill pick up were significantly associated with low VL.
DESCRIPTION: Based on the solutions identified during in-depth consultations with caregivers, stakeholders, and district program managers, we conducted 35 comprehensive health camps for C/ALHIV at ART centres and decentralised sites between October 2021 and September 2022, reaching all C/ALHIV with unsuppressed viral load. Health camps focussed on clinical and nutritional assessment; assessment of ART regimen/dosage; aligning ART refill dates with family members and counselling of caregivers to improve treatment continuity and adherence, and specimen collection for those due for viral load testing. During these camps, we also oriented outreach staff on essential aspects of care for A/CLHIV for sustainable follow up in future.
LESSONS LEARNED: Of the 1,457 C/ALHIV with unsuppressed viral load, ART regimen/drug dosages were modified in 283 (19%) who were not receiving age/weight appropriate regimen/dosages. Pill pick-up dates were aligned for 319 (22%) C/ALHIV whose family members were also receiving ART, but pill pick-up dates not aligned. VL specimens were collected for 266 C/ALHIV due for viral load testing. 246 outreach staff from 13 districts of AP were oriented.
Of the 76% (1109/1457) eligible C/ALHIV who underwent VL testing, 817 (74%) were virally suppressed, improving overall VLS from 65% to 86% (3621 of 4211 C/ALHIV) through September 2022.
CONCLUSIONS: It is feasible to improve VLS and other health outcomes in A/CLHIV through systematic approaches and child friendly services. Child/adolescent-centric differentiated services, including regular clinical monitoring; age-appropriate counselling, particularly addressing health/ HIV related concerns among adolescents; and involvement of caregivers are critical to enhance clinical care and VLS among C/ALHIV.

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