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The United Nations Children’s Fund (UNICEF) reported that ~1 770 000 adolescents were living with HIV infection worldwide in 2018.[1] In the same year, 590 000 young patients aged 15 24 years became infected with HIV.[1] Moreover, in 2016, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that adolescents aged 10 19 years is the only age group in which deaths related to HIV infection are not reducing.[2] HIV infection in adolescents is one of the major challenges for health sectors in sub-Saharan Africa (SSA), as >80% of HIV-positive young patients aged 10 19 years live in this region.[3] The number of HIV-positive adolescents is expected to increase in the future mainly due to a combination of two factors: new infections in adolescents, and the widespread use of paediatric antiretroviral treatment (ART) that will result in HIV-positive children survive and age. Adherence to ART is still a global challenge,[4,5] especially in HIV-positive adolescents.[6] Although better outcomes have been reported in SSA than in Europe and North America,[7] attrition remains a challenge in HIV care programmes for adolescents in many countries in SSA.[8-10] Poor adherence is related to worse general outcomes and scarce control of viral replication.[11,12] This could have several consequences from a public health perspective: increasing transmission rates in the population, the circulation of resistant strains, and an increase in patients needing to switch to secondor third-line treatment.[13,14] There is an urgent need to design programmes that offer more effective interventions to reach a high number of HIV-positive adolescents. Malawi is one of the countries most severely affected by HIV, with a prevalence of 9.2% in people aged 15 49 years,[15] and where ~25 000 boys and 46 000 girls aged 10 19 years are infected with HIV[2] Although interventions that were intended to improve adherence have been widely evaluated,[16-18] evidence on the outcomes of specific adolescent-friendly interventions is scarce.[19] The present study aimed to evaluate a specific adolescent-friendly service implemented Background. The United Nations Children’s Fund (UNICEF) reported that ~1 770 000 adolescents were living with HIV infection in 2017, of whom >80% were in sub-Saharan Africa. In Malawi, ~25 000 boys and 46 000 girls are infected with HIV. Objective. The present study aimed to evaluate a specific adolescent-friendly service implemented in a Diseases Relief through Excellence and Advanced Means (DREAM) health centre in Malawi. Methods. All HIV-positive patients aged 10 19 years in the care of the DREAM centre in Blantyre on 17 December 2016 were included in the study and followed-up until 1 January 2018. The service was organised for one adult-free day, with some side activities managed by a co-ordinator and youth leaders. Assessments were performed at the end of the period (EOP). Results. On 17 December 2016, 425 patients were enrolled in the study. Follow-up status at EOP was 403 (94.8%) patients in care, 7 (1.6%) lost to follow-up (LTFU), 2 (0.5%) died and 13 (3.1%) were transferred to other facilities. Death and LTFU rates were 0.72/100 and 2.9/100 person-years, respectively. Moreover, 50.6% (n=198/391) of patients had an improvement in body mass index (BMI)-for-age z-scores, and 70.2% (n=33/47) of patients who were malnourished at baseline improved (higher improvement in older patients). Mean (standard deviation (SD)) haemoglobin levels increased from 12.5 (1.5) mg/dL to 13.1 (1.9) mg/dL (significance level p=0.000). At the EOP, 79.0% (n=309/391) of patients had viral suppression. Conclusion. Care of adolescent HIV+ patients remains a challenge, but the implementation of specific projects involving adolescents and youth leaders can increase adherence and improve viral suppression.

the south african journal of child health

Evaluation of nutritional conditions, haemoglobin levels, retention in care and viral suppression in a cohort of HIV-infected Malawian adolescents undergoing a one-year tailored intervention within the Diseases Relief through Excellence and Advanced Means