Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade.
Youth living with HIV are at higher risk than adults of disengaging from HIV care. Differentiated models of care such as community delivery of antiretroviral therapy (ART) may improve treatment outcomes. We investigated outcomes across the HIV cascade among youth accessing HIV services in a communit...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002553&type=printable |
| _version_ | 1797294105089277952 |
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| author | Chido Dziva Chikwari Katharina Kranzer Victoria Simms Amani Patel Mandikudza Tembo Owen Mugurungi Edwin Sibanda Onismo Mufare Lilian Ndlovu Joice Muzangwa Rumbidzayi Vundla Abigail Chibaya Richard Hayes Constance Mackworth-Young Sarah Bernays Constancia Mavodza Fadzanayi Hove Tsitsi Bandason Ethel Dauya Rashida Abbas Ferrand |
| author_facet | Chido Dziva Chikwari Katharina Kranzer Victoria Simms Amani Patel Mandikudza Tembo Owen Mugurungi Edwin Sibanda Onismo Mufare Lilian Ndlovu Joice Muzangwa Rumbidzayi Vundla Abigail Chibaya Richard Hayes Constance Mackworth-Young Sarah Bernays Constancia Mavodza Fadzanayi Hove Tsitsi Bandason Ethel Dauya Rashida Abbas Ferrand |
| author_sort | Chido Dziva Chikwari |
| collection | DOAJ |
| description | Youth living with HIV are at higher risk than adults of disengaging from HIV care. Differentiated models of care such as community delivery of antiretroviral therapy (ART) may improve treatment outcomes. We investigated outcomes across the HIV cascade among youth accessing HIV services in a community-based setting. This study was nested in a cluster-randomised controlled trial (CHIEDZA: Clinicaltrials.gov, Registration Number: NCT03719521) conducted in three provinces in Zimbabwe and aimed to investigate the impact of a youth-friendly community-based package of HIV services, integrated with sexual and reproductive health services for youth (16-24 years), on population-level HIV viral load (VL). HIV services included HIV testing, ART initiation and continuous care, VL testing, and adherence support. Overall 377 clients were newly diagnosed with HIV at CHIEDZA, and linkage to HIV care was confirmed for 265 (70.7%, 234 accessed care at CHIEDZA and 31 with other providers); of these 250 (94.3%) started ART. Among those starting ART at CHIEDZA who did not transfer out and had enough follow up time (>6 months), 38% (68/177) were lost-to-follow-up within six months. Viral suppression (HIV Viral Load <1000 copies/ml) among those who had a test at 6 months was 90% (96/107). In addition 1162 clients previously diagnosed with HIV accessed CHIEDZA; 714 (61.4%) had a VL test, of whom 565 (79.1%) were virally suppressed. This study shows that provision of differentiated services for youth in the community is feasible. Linkage to care and retention during the initial months of ART was the main challenge and needs concerted attention to achieve the ambitious 95-95-95 UNAIDS targets. |
| first_indexed | 2024-03-07T21:25:24Z |
| format | Article |
| id | doaj.art-e7a8b03d73a143b284893731a3ae8fc3 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-07T21:25:24Z |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-e7a8b03d73a143b284893731a3ae8fc32024-02-27T05:56:49ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752024-01-0142e000255310.1371/journal.pgph.0002553Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade.Chido Dziva ChikwariKatharina KranzerVictoria SimmsAmani PatelMandikudza TemboOwen MugurungiEdwin SibandaOnismo MufareLilian NdlovuJoice MuzangwaRumbidzayi VundlaAbigail ChibayaRichard HayesConstance Mackworth-YoungSarah BernaysConstancia MavodzaFadzanayi HoveTsitsi BandasonEthel DauyaRashida Abbas FerrandYouth living with HIV are at higher risk than adults of disengaging from HIV care. Differentiated models of care such as community delivery of antiretroviral therapy (ART) may improve treatment outcomes. We investigated outcomes across the HIV cascade among youth accessing HIV services in a community-based setting. This study was nested in a cluster-randomised controlled trial (CHIEDZA: Clinicaltrials.gov, Registration Number: NCT03719521) conducted in three provinces in Zimbabwe and aimed to investigate the impact of a youth-friendly community-based package of HIV services, integrated with sexual and reproductive health services for youth (16-24 years), on population-level HIV viral load (VL). HIV services included HIV testing, ART initiation and continuous care, VL testing, and adherence support. Overall 377 clients were newly diagnosed with HIV at CHIEDZA, and linkage to HIV care was confirmed for 265 (70.7%, 234 accessed care at CHIEDZA and 31 with other providers); of these 250 (94.3%) started ART. Among those starting ART at CHIEDZA who did not transfer out and had enough follow up time (>6 months), 38% (68/177) were lost-to-follow-up within six months. Viral suppression (HIV Viral Load <1000 copies/ml) among those who had a test at 6 months was 90% (96/107). In addition 1162 clients previously diagnosed with HIV accessed CHIEDZA; 714 (61.4%) had a VL test, of whom 565 (79.1%) were virally suppressed. This study shows that provision of differentiated services for youth in the community is feasible. Linkage to care and retention during the initial months of ART was the main challenge and needs concerted attention to achieve the ambitious 95-95-95 UNAIDS targets.https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002553&type=printable |
| spellingShingle | Chido Dziva Chikwari Katharina Kranzer Victoria Simms Amani Patel Mandikudza Tembo Owen Mugurungi Edwin Sibanda Onismo Mufare Lilian Ndlovu Joice Muzangwa Rumbidzayi Vundla Abigail Chibaya Richard Hayes Constance Mackworth-Young Sarah Bernays Constancia Mavodza Fadzanayi Hove Tsitsi Bandason Ethel Dauya Rashida Abbas Ferrand Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade. PLOS Global Public Health |
| title | Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade. |
| title_full | Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade. |
| title_fullStr | Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade. |
| title_full_unstemmed | Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade. |
| title_short | Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade. |
| title_sort | differentiated care for youth in zimbabwe outcomes across the hiv care cascade |
| url | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002553&type=printable |
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