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Title
Mobilizing Operation Triple Zero (OTZ) in the Democratic Republic of the Congo (DRC): using youth-driven programming, self-care, and virtual support communities to improve youth treatment continuity and viral suppression (VLS)
Presenter
Davina Canagasabey
Authors
R. Mwamba1, J. Masusu2, E. Kabange2, M. Kawen2, G. Chomba2, S. Luisi2, D. Canagasabey3, C. Tendo-Bugondo4, P. Milenge Kibwa4, J.-C. Kiluba4
Institutions
1Kheth'Impilo, Lubumbashi, Congo, Democratic Republic of the, 2Independent (former PATH/DRC), Lubumbashi, Congo, Democratic Republic of the, 3PATH, Washington DC, United States, 4PATH, Lubumbashi, Congo, Democratic Republic of the

BACKGROUND: Low VLS among youth persists in the DRC: VLS ranged from 33% (males 1–4 years) to 93% (females 10–14 years) in September 2020. OTZ is successfully used in Kenya to improve adolescent adherence and VLS. The USAID/Integrated HIV/AIDS Project in Haut-Katanga adapted OTZ for DRC to improve youth treatment adherence, continuity, and VLS.
DESCRIPTION: Using human-centered design, we worked with adolescent support group members to co-adapt Kenya’s OTZ model. Under our model, three age-stratified OTZ club types were created: youth under–10 and youth 10–14 years (added focus on HIV status disclosure) and adolescents 15–18 years (added focus on positive peer prevention).
Each club member committed to the three zeros: zero missed appointments, zero missed treatment doses, zero viral load. Additional commitments by specific clubs included zero unprotected sex and zero self-stigma. We integrated virtual support components with each club sending daily reminders/support messaging and peer facilitators sending appointment reminders and missed appointment follow-ups via using WhatsApp or SMS. We piloted this model at three high-volume facilities from May 2021–September 2022, assessing its impact on treatment and viral load (VL) outcomes.
LESSONS LEARNED: 110 and 140 youth enrolled in six OTZ clubs in fiscal year 2021 and 2022, respectively. Improvements were observed across all tracked outcomes between fiscal years—self-reported adherence and continuity (77% to 90%); VL coverage (53% to 90%); and VLS (71% to 94%)—with two- and three-fold increases in members with active VL counts and suppressed VL, respectively (table).
WhatsApp/virtual messaging facilitated accountability and on-demand support for club members, improving outcomes. Peer facilitators and members leading follow-up and peer prevention campaigns empowered them to collectively manage health goals. Medical directors’ involvement in OTZ meetings was critical for active, sustained facility engagement.

FY21 (May–Sept 2021)FY22 (Oct 2021–Sept 2022)
# Operation Triple Zero club members110140
# members with zero missed refill appointments (%)85 (77%)126 (90%)
# members with zero missed doses (%)85 (77%)126 (90%)
# members with active viral load results (% coverage)58 (53%)113 (90%)
# members with suppressed viral load (% suppression)41 (71%)106 (94%)

CONCLUSIONS: Results showed our adapted OTZ model is feasible and effective in improving clinical outcomes for youth. HIV program implementers should scale this model across DRC to address persisting issues of sub-optimal pediatric VLS.

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