UCSF Pediatrician Helps Individualize HIV Care for Young Adults in Sub-Saharan Africa
Adolescents and young adults living with HIV in sub-Saharan Africa face a unique set of hurdles as they transition to adulthood, often leading to disruptions in their medication adherence and HIV care. A new, comprehensive intervention known as SEARCH-Youth provides dynamic support to these at-risk young people to help them stay engaged with care and keep healthy.
Through long-standing collaborations in Uganda and Kenya, research by faculty at UCSF has demonstrated that community-based test-and-treat strategies can result in high uptake of effective treatment for HIV. However, those gains did not reach all ages equally; adolescents and young adults had much poorer outcomes than older adults.
To address that gap, a team including Theodore Ruel, MD, Professor of Pediatrics and Chief of the Division of Infectious Diseases and Global Health, developed and tested the SEARCH-Youth intervention. Drs. Ruel and Florence Mwangwa, who works with the Infectious Diseases Research Collaboration in Uganda, recently published the results of the cluster randomized trial that included nearly 2,000 youth in 28 rural clinics in The Lancet HIV.
Accommodating Young People’s Needs
Ruel says the SEARCH-Youth intervention “included a life-stage based discussion tool that was designed to create a collaborative relationship between providers and patients, enabling them to identify and navigate new barriers to care and treatment adherence.”
Youth were offered alternative times to access care at the clinic and phone-based counselling. The intervention also included rapid viral load testing for immediate feedback about care adherence or lapses, which can be particularly helpful for young people who are still developing their abstract thinking and ability to appreciate long-term consequences.
Improved Rates of Virologic Suppression
Overall, the intervention clinics had a 10% increase (80% vs 88%) in the proportion of patients who met the goal of virological suppression after two years in the study. Perhaps equally important, patients in the intervention group were much more satisfied with their care than those in the control group.
“One of the main drivers of poor outcomes in young people living with HIV in sub-Saharan Africa is disengagement from care, especially among adolescents and young adults,” explains Ruel. “A key part of our success is demonstrated by the fact that 91% of patients had been in contact with the intervention clinics in the last 6 months, compared to 72% for the control clinics.”
While there is still work to be done to reach all youth, Ruel says that “our study showed important incremental progress in helping youth achieve higher rates of virologic suppression and details how clinics can accommodate the many stresses and psychosocial changes that occur during the transition to adulthood.”