Youth supporter program improves adolescent access and linkage to HIV testing, care and treatment in Malawi
While young people continue to be at high risk of HIV infection, they are less likely to test for HIV, take HIV treatment, and be virally suppressed than adults. In Malawi, only 50% of youth aged 15-24 years know their HIV status. Of those who are living with HIV, 82.5% are on antiretroviral therapy and 78.8% are virally suppressed – lower rates than for adults in the country.[1] The number of adolescents living with HIV is also growing due to increasing numbers of new infections among youth, as well as perinatally-infected children surviving into adolescence and adulthood as a result of improved antiretroviral drug regimens.
Youth – including adolescents living with HIV – are less likely to access services for multiple reasons, including service provider attitudes towards youth, transport costs, inconvenient clinic hours, long waiting times, lack of privacy, and fear of stigma and disclosure. |
In recognition of these challenges, Malawi implemented youth-friendly health services in 2007 to increase access to and uptake of HIV, sexual and reproductive health (SRH), and family planning services that are appropriate and acceptable to young people aged 10-35 years. Despite the introduction of these services, Malawi has experienced an increase in HIV infections among the youth, representing 30% of all new HIV infections.[2]
It is critical to implement targeted strategies for these special populations. While government and donor-funded programs have developed effective, specialized services for youth (including those living with HIV), these interventions can be costly, which limits their scalability. In response, the USAID-funded Tingathe program, implemented by Baylor College of Medicine Children’s Foundation-Malawi, has developed and piloted a Community Health Worker (CHW) Youth Supporter program to improve HIV service provision to youth in central and southeastern Malawi. Youth Supporters assist adolescents in accessing SRH services, such as HIV testing and family planning. They link newly-diagnosed adolescents to HIV care and support adolescents living with HIV with disclosure and adherence, ensuring they receive viral load testing, their results, and appropriate follow-up. The Youth Supporters also connect young people to community support groups and psychosocial counselling when needed.
The CHW Youth Supporter program was piloted at 15 health facilities in three districts in Malawi: Balaka, Mangochi, and Salima. Each health facility has two CHWs and a Ministry of Health staff member who have been equipped with basic psychosocial counseling skills and advanced training on relevant health topics, including SRH, mental health, treatment adherence, stigma, and disclosure. In September 2018, the program tested over 4,000 adolescents for HIV across the three districts.
Fifteen-year-old Memory[3] is one of the adolescents who has benefitted from the program. She learned that she was living with HIV when she went to the hospital due to recurring illness and was offered testing by the health facility staff. “I was in great denial and it took me almost a week to accept my status,” Memory said. “I disclosed my status to my relatives and they encouraged me to start treatment. I was shy and afraid of stigma and discrimination from my community, so I opted to start at Mangochi District Hospital rather than my nearest health center.” Memory attended sessions with Tingathe’s psychosocial counsellor Gideon Kaunda. “I received full support and I was put into the Teen Club program for easy appointments with the clinician,” she shared. “I am now living a healthy life and am able to access ART services whenever I go to the hospital.”
The Youth Supporter program has also helped bring clients back to care. One of these is Sephora,[4] a 19-year-old who was diagnosed with HIV in December 2017. Sephora found it difficult to accept her HIV status and experienced side effects on treatment. She stopped attending her appointments. Tingathe staff contacted her several times, encouraging her to return to the hospital to continue with treatment. Gideon and other team members visited Sephora on December 19, 2018, and found her to be very sick. They brought her to the hospital and provided intensive adherence counselling and psychosocial counselling, which helped her to accept her status and re-start treatment. One of Tingathe’s CHWs is continuing to provide one-on-one follow-up and support to monitor Sephora’s adherence and wellbeing.
Preliminary implementation results from the Youth Supporter program demonstrate improvements in the rates of youth diagnosed with HIV being linked to treatment and care. The program began in quarter three (April-June 2018) and Youth Supporters were fully trained and implementing the program by quarter four (July-September 2018), with the highest linkage rates achieved in October and November 2018. The program will continue to monitor program progress in terms of linkage rates, as well as viral load testing coverage and suppression.
These early results show promise of a youth-centered, effective model for improved HIV service delivery in Malawi. Tingathe will continue to implement the Youth Supporter program and share its results for potential application in other areas of the country. |
[1] Malawi Population-Based HIV Impact Assessment (MPHIA) 2015-2016. Available at: https://phia.icap.columbia.edu/wp-content/uploads/2017/11/Final-MPHIA-First-Report_11.15.17.pdf
[2] UNAIDS Data Book 2017. Available at: http://www.unaids.org/en/resources/documents/2017/2017_data_book
[3] The name Memory is a pseudonym
[4] The name Sephora is a pseudonym
[1] Malawi Population-Based HIV Impact Assessment (MPHIA) 2015-2016. Available at: https://phia.icap.columbia.edu/wp-content/uploads/2017/11/Final-MPHIA-First-Report_11.15.17.pdf
[2] UNAIDS Data Book 2017. Available at: http://www.unaids.org/en/resources/documents/2017/2017_data_book
[3] The name Memory is a pseudonym
[4] The name Sephora is a pseudonym