Union study in Myanmar spurs improved adolescent-specific care in HIV care programmes

Improved services catering towards adolescents living with HIV have increased retention of young people treated through The Union’s Integrated HIV Care (IHC) Programme in Myanmar. The need for such initiatives were highlighted in a recently published Union study, which showed that adolescents living with HIV in the IHC programme saw poorer outcomes compared to younger children treated through the programme.  The findings underlined the need for focused attention towards providing additional care to adolescents living with HIV, something which had already resulted in a series of changes to IHC practice.

To that aim, The Union has supported the creation of counselling services, peer education and support groups and youth club activities. With a particular focus on adolescents – those between 10 and 19 years of age – the IHC Programme provided training on the HIV virus, preventing transmission, ART and its side effects, and nutrition. The participants were supported to form the Young People Living with HIV Volunteer Network. Now formed, the group meets monthly, with youth leaders and IHC medical officers providing group activities, discussions, peer education and peer counselling. Ongoing ‘refresher training’ is provided to the adolescents regarding their knowledge-base of HIV, their adherence to the programme, and learning about healthy life skills. Planning is underway to expand these activities to other IHC sites where paediatric HIV care is implemented.

Other services offered to adolescents include improved systematic disclosure counselling, and a new annual training is offered to paediatricians and medical and social workers to update their knowledge of paediatric and adolescent HIV care and counselling. Such activities take place alongside other longer-term initiatives such as annual ‘Fun Days’.

These initiatives were set up by programme managers aware of the challenge of retaining adolescents in HIV care. The scale of the problem was recently quantified in a paper, published in the Journal of Epidemiology and Infection, by Thurain Htun and an entirely Union team. The study analysed the attrition rate of adolescents living with HIV on ART. The attrition rate refers to the rate of adolescents who are lost to follow up or death.

Study results, which analysed routine data on adolescents in HIV care between July 2005 and June 2017, indicated that attrition rates were highest during the initial one to two years, due to late diagnosis and enrolment in treatment, and after five to six years of treatment, indicating waning immunity or reduced effectiveness of ART.

Previous studies show that adolescents living with HIV encounter stigma and discrimination that can hinder regular follow up on ART. Assessing and addressing context specific reasons for late enrolment, presence or absence of virological failure and other psychosocial aspects that hinder adolescents from continuing on ART in the setting is an area for further research.

This is the first study from Myanmar describing the retention of adolescents on HIV care over a 12-year period. When compared to studies done on adolescents in African countries, the overall attrition rate was relatively lower in Myanmar, indicating better organisation and/or delivery of services under the IHC Programme.

However, the higher attrition rates for adolescents receiving ART care under IHC than children, reinforces the need to design and deliver additional care tailored to the needs of adolescents, considering barriers such as accessing health care and availability of psychological support, healthcare workers trained on adolescent healthcare issues and support during transition from paediatric to adult care.

Through regular data collection and evaluation such as this, the IHC Programme is able to monitor progress, address gaps in care, ensure positive health outcomes and build a high performing programme.

The IHC Programme has been implementing HIV care in Myanmar since 2005, providing over 30,000 patients with ART. The IHC programme works in close collaboration with the National AIDS Programme, the Department of Public Health and the Ministry of Health, with funding from Total E&P Myanmar and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

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