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A NOVEL MODEL OF COMMUNITY COHORT CARE FOR HIV-INFECTED ADOLESCENTS IMPROVES OUTCOMES
Lindsey Reif1, Rachel Bertrand2, Vanessa Rivera3, Bernadette Jospeh2, Benedict Anglade2, Jean W. Pape3, Daniel Fitzgerald3, Margaret McNairy3
1Columbia Univ, New York, NY, USA,2GHESKIO, Port-au-Prince, Haiti,3Weill Cornell Med, New York, NY, USA
Adolescents account for 40% of new HIV infections in Haiti and have worse outcomes than other age groups. A novel model of community cohort care was implemented to improve retention and viral load suppression among HIV+ adolescents in Port-au-Prince, Haiti. The intervention addressed barriers of social isolation, stigma, and long visits reported among adolescents.
Adolescents 10-20 years, who newly tested HIV+ were enrolled in cohorts of 8-10 peers, stratified by age group – 10-15 and 16-20. Cohorts met monthly for integrated clinical care, counseling, and social activities in a community setting. All clinical services (laboratory tests, ART initiation/management, and pharmacy refills) were performed during the cohort meeting by a nurse; group counseling was provided by a peer counselor. Retention at 12 months was defined as being alive with a visit between 11 and 13 months from enrollment. Viral load suppression was defined as <1000 copies/ml. Retention was compared between cohort care participants and teens receiving standard care at the Adolescent Clinic between 2009 and 2012. Kaplan-Meier methods estimated incidence of retention.
Fifty adolescents enrolled in cohort care between Nov 2014-Sept 2015 – 80% females, median age of 18 (IQR 15-19), and median CD4 count 537 cells/mL (IQR 339-805). In standard care, 710 adolescents enrolled in care from Jan 2009-Dec 2012 – 80% female, median age 18 (IQR 16-19), and median CD4 count 414 cells/mL (IQR 238-604). In cohort care, 100% of adolescents were assessed for ART eligibility on the day of testing, 22 (44%) were eligible for ART with CD4 <500 cells/uL, and 100% started ART with median time to initiation of 0 days. In standard care, 462 (65%) adolescents were assessed for eligibility, 330 (46%) were eligible with CD4 <350 cells/uL, and 305 (92%) started ART with median time to initiation of 20 days. At 12 months from enrollment, 86% (95% CI: 74-92) of adolescents in cohort care were retained compared to 66% (95% CI: 63-67) in standard care (p<.001) (Fig 1). In cohort care, among those with a viral load measurement 6-12 months from ART initiation, 5/19 (26%) had viral suppression. Viral load was not routinely collected prior to 2016.
Community-based cohort care for HIV+ adolescents in Haiti significantly improved retention by an absolute difference of 20% and decreased time to ART initiation. Viral suppression remains poor indicating a need for increased efforts to improve adherence to ART among adolescents.