Expanding Differentiated Care Approaches for Adolescents Living with HIV
NAMHC Concept Clearance •
Susannah Allison, Ph.D.
Division of AIDS Research
The goal of this concept is to develop and test novel approaches to delivering differentiated care to adolescents who are living with HIV around the world.
Adolescents and young adults represent a growing share of people living with HIV worldwide. In 2018, approximately 1.6 million adolescents between the ages of 10 and 19 were living with HIV. While there are numerous efforts to increase HIV testing and improve HIV care, adolescents living with HIV (ALWH) have some of the poorest outcomes along the HIV care continuum. Estimated annual HIV-related deaths among adolescents have increased by about 50%. While the scale up of antiretroviral therapy (ART) has been successful, different approaches to the delivery of care are needed especially among subpopulations such as adolescents.
Differentiated care or differentiated service delivery is defined as client-centered approaches that simplify and adapt HIV services across the care continuum, in ways that both better serve the needs of adolescents living with HIV and reduce unnecessary burdens on the health system. Most of the data on differentiated care has been limited to ART delivery for stable adults in high-prevalence settings in sub-Saharan Africa. A recent supplement to the Journal of the International AIDS Society on differentiated care and HIV provides data to support these new approaches to providing care to PLHIV; however, programs rarely target the unique needs of ALWH.
Adolescence represents a unique period of development. It is characterized by enormous changes in biological, social, psychological, neurodevelopmental, hormonal, and immune functioning. ALWH are a highly heterogeneous group both due to the significant number of changes/transitions that occur during this time but also since some individuals have been living with HIV since birth, while others are only recently infected. Given the unique developmental context, differentiated care approaches directed specifically to adolescents are needed. For example, while adults appear to benefit from community-based adherence clubs, some data suggest that clubs do not help reduce loss to follow up among youth. Other unique adolescent factors that may need to be taken into account include the level of family support, school attendance, and disclosure to family and peers. Some researchers have attempted to take these unique needs into account by having set days when children and adolescents are seen for care and more frequent monitoring for adolescents especially if they are experiencing increased growth; however, much more work in this area is needed.
This concept would solicit research to target gaps in knowledge regarding the delivery of differentiated care to ALWH with the goal of developing and testing interventions to improve treatment outcomes for ALWH.
Responsive research topics include, but are not limited to:
- Studies to develop differentiated care approaches to assist with transitioning ALWH to adult care to improve health outcomes and reduce the number of ALWH who are lost to follow up;
- Studies to determine what aspects of mHealth technology are useful in improving retention in care and helping to re-engage ALWH in care;
- Studies to develop and test out-of-facility models to re-engage ALWH in HIV care. For example, using non-physician providers, community-based venues, schools, etc. Specific attention may be needed for key adolescent subgroups such as street youth, sex workers, and YMSM.