Improved propotion of viral suppression of children aged 1-19 years attending care and treatment clinic at Misasi health centre in Misungwi district-Mwanza region in Tanzania April2019 to March2020

Authors:Dr.Ayoub KennethMsalilwa*,Debora William Luhiguza1

Co-Author:Dr. BenNahayo2, Dr.Peter Shilogile3,Violet Rugangila4

Background

Misasi Health Centrein Misungwi District Council in Mwanza Regionis among the health facilitysupported byAriel Glaser Pediatric AIDS Health Initiative (AGPAHI) on

comprehensive HIV care and support, the major service forclient on Anti-RetroviralTreatment(ART) is to achieve viralsuppression or undetectable viral loads indicative of treatment success.Undetectable simply means that the virus population has fallen below testing detection levels in the blood but could be detectable elsewherein body reservoirs such as lymph nodes.

According to the Fourth Health Sector HIV/AIDS Strategic Plan (HSHSP)IV-2017/2022, PVLS Strategic outcome stipulates that 90% of people living with HIV should be virally suppressed by 2020. However,at Misasi Health Centre viral suppression was 66.7% by April 2019 of which the suppression lags behind the national targetof 100%by 23.3%. Poor adherence, Missed Appointment (MissAP), Lack of disclosureART under dosage, Poor monitoring of clients with high viral load were the underlying factors.

Inclusions and Exclusion Criteria
 
Inclusion criteria
  • Children and adolescents aged 1-19years who are currently on ART
  • Children and adolescents who had a High Viral Load after the first viral load test
Exclusion criteria
  • On transit children and adolescents aged <20 years.
Implementation
  • Meeting with Community Health Workers (CHWs)to Identify the underlying causes that contribute to high viral load, Categorizing children with a high viral load intoage groups(0-4,5-10and 11-19years) and follow up on the monthly implementation status.
  • Establishing EnhancedAdherence Counselling (EAC)register specificallyfor children and Adolescents.
  • Reinforcement of ART refill strategy by providing exact pills without extra pill for an emergency to clients near the facility, in case of emergency offerpills with a single extra pill, and conducting pill count and adherence check in every visit.
  • Ensuring ART Optimization as per national guideline•Combiningadolescent with high viral load with suppressed Peersfor experience learning
  • Monthly in house visit by Community Based Health Service (CBHS) /Lay counselor to clients

Trends of Viral Suppression

 
Indicator April May June July August September October November December January2020 February2020 March2020
VL Results 9 12 2 1 3 13 14 35 3 3 9 4
Suppressed 6 5 1 0 2 10 14 29 2 2 9 4
Unsuppressed 3 7 1 1 1 3 0 5 1 1 0 0
%Suppression

66.7

0%

41

70%

50

00%

%0

66

70%

76

90%

100

00%

83

00%

66

70%

66

70%

100

00%

100

00%

%of Unsuppressed

33.3

0%

58

30%

50

00%

100

00%

33

30%

23

10%

0.00

%

17

00%

33

30%

33

30%

0.00

%

0.00

%

Trend of Viral Suppression among children aged 1-19years who are on ART for more than 6months

Trends of Viral Suppression Trends after Enhanced Adherence and Counseling(EAC)

Month April May June July August September October November December January2020 February2020 March2020

Started

EAC

3 7 1 1 1 3 0 5 1 1 0 0
Suppressed 3 6 1 1 1 3 0 5 1 1 0 0
%  Suppression

10

0%

86

%

100

%

10

0%

100

%0

100

%

100

%

100

%

100

%

100% 100% 100%

Tend of Viral suppression among childen withage 1-19years after EAC session

Results

  • The unbalancedtrend of viral suppression observed April to June as HVL results returnedbefore the initiative.
  • Viral suppression was 0% in July as there was only one HVL result returned which had high VL
  • An exponential rise in viral suppression observed from August to October where it reached a peak by 100% suppression in October 2019
  • Furthermore,23with high VL identified from April 2019to March 2020were enrolled in EAC in which 22were virally suppressed, 1 had a log drop of >0.5. This client was suppressed later on further EAC.

Drawbacks

  • Lack of incentives to support CBHS and HCWs providers for a home visit
  • Lack of incentives to support peer for peer to peer learning
  • Fluctuations of pediatric optimal regimens

Recommendations and conclusion

Improvement of viral suppression among children and adolescents is possible despitemany challenges underlying this aged group.Asithas been observed at Misasi HC, viral suppression has been achieved by 100%.Therefore,to achieveviral suppression to children and adolescents Misasi HC team recommend the following change strategies;Site-level team involvement, Use EAC register special for children, Reinforcement of ART refill strategies, ART optimization, Peer learning and supportclose monitoring of EAC session.

This experience of improved viral suppression of children aged 1-19 years current on treatment gives us evidence that accountability, teamwork at the facility, availability of EAC register, and close monitoring of EAC session and given support from (AGPAHI) through theCentre of Diseases Control and Prevention (CDC)-funded program in Mwanza Region has added value for retention of PLHIV on care and treatment.

Acknowledgment

AGPAHI acknowledges the following team from Misasi HC for their full participation in achieving 100% viral suppression to children and adolescent attending Misasi CTC clinic.

  • Paskal Kalinga-Facility Incharge
  • Lucy Rwehula –Adherence Nurse
  • Emmanuel Paulo –Community Based Health Service (CBHS)provider
  • Mussa Baya –CBHS provider
  • Caritas Gaudence–LayCounsellor (LC)
  • Kaponda Misungwi -LC

Annotation

*Program Officer Pediatric HIV/AIDS_-AGPAHI Mwanza

  1. CTC Incharge Misasi HC-Misungwi DC
  2. Regional Program Coordinator-AGPAHI Mwanza
  3. Program Coordinator, Pediatric HIV/AIDS-AGPAHI
  4. Program Coordinator, Training & Capacity Building-AGPAHI Dar es salaam
 

 

What We Do

  • Provision of Comprehensive HIV Care +

    The purpose of** Boresha Project** is to support comprehensive facility-based HIV testing, care, treatment and support service provision in 9 scale-up and 25 sustained districts in the five lake zone regions of Geita, Mara, Mwanza, Simiyu and Shinyanga. .

  • CIFF Reprogramming +

    Project Goal is to improve health services to prevent HIV transmission, increase identification of adolescents with HIV infection, and improve HIV care and treatment and retention for ALHIV in Tanzania.

  • TB in the Mining Sector Programme +

    TB in mining sector (TIMS) project is funded by Global fund through Development Aid from People to People (ADPP - Mozambique). AGPAHI is a sub-recipient of ADPP Mozambique.The project target is to screen TB to approximately 30,000 mine workers and their families.

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