Title

Implementation of a Quality Improvement collaborative of HIV status disclosure of Young People Living with HIV in Zimbabwe

Presenter

Ann Sellberg

Authors

A. Sellberg¹, B. Tapesana¹, B.B. Khabo¹, V. Chitiyo¹, N. Willis¹, F. Mavhunga¹, T. Magadza¹, T. Takundwa¹, K. Thomson², S. Wiktor², Z. Bangani³, T. Maphosa³, T. Apollo⁴, E. Govha⁴, B. Makunike-Chikwinya⁵, G. Gonese⁵

Institutions

¹Zvandiri, Harare, Zimbabwe, ²University of Washington, International Training and Education Center for Health, Washington, United States, ³CDC, Harare, Zimbabwe, ⁴Ministry of Health and Child Care, Harare, Zimbabwe, ⁵Zimbabwe Technical Assistance, Training, and Teaching Centre for Health, Harare, Zimbabwe

BACKGROUND: Despite the progress made in HIV services, treatment and mental health outcomes of Adolescents and Young People Living with HIV (AYPLHIV) remain suboptimal, of which non-disclosure to the AYPLHIV of their HIV status is a key factor. To address this challenge, the Ministry of Health and Child Care (MoHCC) of Zimbabwe recommends that full disclosure be done before 10 years of age, yet Zvandiri programmatic data (May 2022) showed that 1,443/6,666 (22%) of AYPLHIV aged 10-14, and 389/9,149 (4%) of AYPLHIV aged 15-19 were not disclosed to. Zvandiri connects AYPLHIV with trained, mentored, peer counsellors. We utilised a Quality Improvement (QI) collaborative from April to September 2022 to improve disclosure status among AYPLHIV across three selected districts (Hurungwe, Nkayi, and Goromonzi).
DESCRIPTION: As part of the QI collaborative, the Zvandiri District Team (ZDT) engaged Health Care Workers (HCW) and peer counsellors to elucidate the disclosure status of supported AYPLHIV. AYPLHIV who were not fully disclosed to were identified and followed up for disclosure support. The QI package included documentation of disclosure status in health care files, monthly caregiver support meetings and individual additional counselling, and HCW Initiated Opt-out Disclosure Sessions (HIODS).
LESSONS LEARNED: The disclosure rate increased from 959/1319 (73%) to 1266/1319 (96%) over six months as all AYPLHIV without full disclosure and their caregivers received the QI package of disclosure support. Of the 53 (Female:36, Male:17) AYPLHIV who did not receive full disclosure, 45/53 (85%; Female:30, Male:15) were aged 10-14 and 8/53 (15%; Female:6, Male:2) were aged 15 and above. Reasons for non-disclosure:

12/53 (23%) absent primary caregiver
26/53 (49%) caregiver unwilling to disclose
4/53 (8%) AYPLHIV with cognitive impairment
11/53 (21%) disclosure process ongoing

CONCLUSIONS: The QI collaborative was successful in improving disclosure status among AYPLHIV, which is expected to improve retention in care, mental health status and overall treatment outcomes for the AYPLHIV. This initiative has demonstrated the importance of active follow up and documentation of disclosure status among AYPLHIV, in addition to caregiver counselling and HIODS. Primary caregivers working abroad posed a special challenge, as the secondary caregivers were hesitant to disclose in their absence.

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