Int. Workshop on HIV & Adolescence 2019
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Mental Health and Psychosocial Support
Dr Sarah Berneys opened with the keynote presentation Beyond cells and pills: seeing all that matters. The key message focused on the importance of psychosocial support and called for this to be the 4th 90 in the HIV cascade. Dr Berney’s discussed the important relationship between ART adherence and psychosocial challenges. She highlighted how mental health challenges lead to negative physical health outcomes. And for ALHIV who have been seen to have a higher prevalence of mental health disorders, that poor adherence is often a symptom of psychosocial challenges they are facing. She also provided examples of interventions of psychosocial support that has led to better mental health outcomes.
We heard four oral abstracts with the following key messages:
- Prevalence of Mental Health and Social Well-being Issues among Pregnant Adolescent Girls and Young Women in Western Kenya. Depression symptoms were common among pregnant AGYW and were associated with higher HIV risk perception and IPV, and lower availability of social support. Integrating social and mental health care within existing health systems frequently used by AGYW will be key in addressing the burden of depression.
- Prevalence and Correlates of Depressive Symptoms among Adolescents in a Population with High Prevalence of TB/HIV in Zambia and South Africa: HPTN 071 (PopART) for Youth study. Factors associated with self-reported depressive symptoms included: ever have had sex; HIV related stigma; presumptive TB; did not use a condom during last sexual encounter and used alcohol/drug during last sexual encounter.
- Self-disclosure of HIV Status by Adolescents and Young Adults is Associated with Higher Levels of Enacted and Internalized Stigma. This study highlighted the positive and negative aspects of HIV self-disclosure. Those who self-disclosed indicated more internalize stigma and depression. Future disclosure counselling should be accompanied by depression screening.
- Piloting a Psychosocial Support Program to Target Adolescent Girls and Young Women Living with HIV at Baylor-Tanzania. The programme created adolescent girls’ friendly zone for sharing views and peer support improving retention, viral suppression, prevention of MTCT, and prevention of unplanned pregnancies: it increased engagement into care up to 93% from <70% before implementation.
Elizabeth Glaser Pediatric Aids Foundation: Does it take a village to support treatment-experienced adolescents living with HIV?
The symposium opened with keynote presentations by Natella Rakhmanina, on Switching ART Regimen: Why, When, and How?; and Disclosing HIV status: Mission Possible by Judith Kose. The presentations introduced two important programme tools developed by the Elizabeth Glaser Pediatric AIDS Foundation – 1) New Horizons Advancing Pediatric HIV Care Collaborative Management of Treatment Failure for Pediatric and Adolescent Patients Resource Package and 2) Disclosure of HIV Status Toolkit for Pediatric and Adolescent Populations. Dr Rakmanina’s presentation focused on the need for switching to be patient-centred and the need to change the language around ‘failing’ ART. Dr Kose focused on the steps needed in the disclosure process as not a one-time event and that it needs to be planned with the caregiver, the health worker, and the adolescent.
Scaling up interventions: improving the quality and sustainability of programs
The last session of the day focused on Scaling Up Services to ensure no adolescent is left behind. A panel discussion with Government representatives, focusing on the key role that both Government and partners play in scaling up services. Dr Alice Ketchaji from Cameroon mentioned the importance of disaggregated data to appropriately target services. The requirement for cost effective interventions was highlighted D. Laura Oyiengo from Kenya. From Namibia Dr Sylvia Ashikoto discussed efforts to provide a targeted package of care for ALHIV through Teen Clubs and have national guidance to support scale-up. Overall there was a call for partners and researchers to consider key aspects of scale when designing interventions.
We heard three oral abstracts with the following key messages:
- Cost-Effectiveness of a Combination Intervention to Improve Retention and Viral Suppression among HIV-Positive Adolescents in Kenya: The ACT Adolescent Project Study. Providing conditional incentives such as water bottles, t-shirts, wristwatch, geometry kit for adolescents 10-19 years was found to be acceptable and improve viral suppression as well as cost effective, with a year gained of productive life for every 33 dollars invested.
- Improving HIV Case Identification for Adolescents and Young People through Assisted Partner Notification (APN) approach: Implementation Progress in Uganda. Contact tracing through APN is a novel strategy in identifying undiagnosed AYPLHIV. This approach had 22% HIV positive yield for adolescents and young people compared to 3% in conventional HTS.
- Thetha Nami: Implementation and Early Lessons Learnt from a Peer-Support Program to Improve Uptake and Retention in Multi-Level HIV Prevention for Adolescent Girls and Young Women in Rural South Africa. Engaging peer navigators in delivery of HIV interventions is effective in reaching young people, especially with the endorsement of community and traditional leaders, schools and parents. Seventy percent of young people were noted to prefer attending the mobile clinic rather than a fixed facility.
The close of the 2019 Int. Workshop on HIV & Adolescence was marked with recommendations from the Youth Reference Group, final comments from Workshop Co-Chairs and a video of highlights.
This workshop was seen to be unique in the way that is brought together key stakeholders and generations on issues across the whole adolescent HIV prevention, treatment and care cascade. It placed adolescents and young people front and centre, driving and participating in all sessions. This years’ aim to have research-driven approach was a success with high numbers of quality abstracts, posters and oral presentations. Hearing real-life stories of adolescents, as well as the latest evidence, created an important dynamic. For next year the Youth Reference Group recommended that all presentations aim to reach a diverse audience, with easier to understand, youth appropriate language. They highlighted the need for more youth researchers to be given opportunity, additional time for dedicated skills building and the importance of including young key populations.
The keynote speakers and oral abstract PowerPoint presentations will be available on infectiousdiseasesonline.com very soon!
Special thanks to the oral and poster presenters, the volunteers from Maisha Youth, the Youth Reference Group, the Organising Committee, the Scientific Committee, our endorsers and sponsors.
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