Enhanced Adherence Counselling, Support Groups and Viral Load Suppression amongst HIV-Positive Adolescents in a Tertiary Health Care Facility in Cameroon
Background: Globally, HIV viral load suppression rate, which is an indirect measure of the efficacy of antiretroviral (ART) medication, is 47% and 52% in Africa. In Cameroon, the viral load (VL) suppression rate is 44.7% and poor adherence is widely documented as being responsible for the large gap in VL Suppression. Enhanced adherence counselling (EAC) sessions, and enrolment and participation in support groups are specific interventions to improve ART adherence and improve viral load suppression. Purpose: This study assesses the uptake and contribution of support groups and EAC sessions in the management of adolescents with unsuppressed VL results at Centre Hospitalier d’Essos, Yaounde. Methods: A retrospective correlational quantitative patient files review was conducted for 138 files of HIV positive adolescents aged between 10 - 19 years with HIV VL above 1000 copies/ml enrolled in care between January 2009 and December 2019. Data from the questionnaire was entered into CSPRO version 7.4. and analyzed by using SPSS version 25.0. Results: A total of 138 participants (75 females and 63 males) with a mean age of 15 ± 3 years were included in our study. Sixty-nine (50%) participants were in World Health Organization (WHO) stage I; 32.6% were in Stage II; 13.0% and 4.3% were in stages III and IV, respectively. Thirty (21.7%) had a history of tuberculosis and 76% of the adolescents were being cared for primarily by their parents. The charts of the adolescents revealed that there was an association between completion of EAC sessions in adolescents with unsuppressed VL and eventual VL suppression (R.R = 2.5; CI 0.848 - 6.162; p = 0.033). However, there was no significant association between support group enrolment and active participation, and eventual VL Suppression. Furthermore, combining EAC and support group interventions was strongly associated with eventual VL Suppression in this group of initially unsuppressed adolescents (R.R = 7.5; C.I 2.544 - 22.360; p < 0.001). Conclusion: Suppression rates were good after completion of EAC sessions and participation in support group enrolment for adolescents with a high VL. As we move towards having 95% of ART-treated adolescents achieve and maintain viral suppression, there is a need to reinforce EAC sessions and support group enrolment in ART clinics targeting this priority group.
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