Advancing care for HIV-positive children and adolescents in Kenya

On World AIDS Day, the global community has committed to ambitious targets focused on ending the HIV/AIDS pandemic. New targets set by the Sustainable Development Goals and the President’s Emergency Plan for AIDS Relief, for example, focus on improving HIV prevention, treatment and care for children and adolescents – particularly girls and young women.

The UCSF Bixby Center’s FACES Program has a new project to help reach these global goals, thanks to a $2.7 million grant from the Children’s Investment Fund Foundation. Our project will find answers about how to best provide HIV/AIDS care and services to youth by identifying all HIV-positive children and adolescents in the FACES region of Western Kenya, providing them with treatment access and rigorously evaluating treatment outcomes.

Meeting Kenya’s goal to end HIV/AIDS

The new FACES program will focus on Kenyan children and adolescents because only 53 percent of them were receiving HIV treatment as of December 2014. Achieving the ambitious goals in Kenya’s AIDS Strategic Framework by 2019 makes reaching underserved young people a priority. We’ll accomplish this goal by using a range of innovative strategies to increase HIV testing, connect patients with care, and help them stay in care.

Increasing HIV testing and awareness

One of our main goals is to increase HIV testing and counseling for children and adolescents throughout our 140 clinics, and through efforts like home-based testing and outreach to orphans and vulnerable children. To help manage the impact of a ramped-up testing in clinics, the program will build staff capacity and help strengthen health systems.

We will also work with community groups and schools to spread messages about the importance of HIV testing, create youth-friendly testing centers, and hire peer champions to educate adolescents and children on the importance of HIV testing.

Connecting patients with care quickly

As more children and adolescents discover their HIV-positive status, we will prioritize enrolling them in care programs on the same day as testing. We will use texting and mobile phones to trace patients and follow up on their care. We will also work with a program that sends interactive text messages to HIV-positive pregnant women, connecting newly identified HIV-positive women and their infants to services.

Helping children and adolescents stick with HIV care

Because it is critical to start children on antiretroviral therapy (ART) as soon as possible, we are working to identify all children and adolescents eligible for ART. For example, FACES caregivers will use a mobile text message system to quickly convey test results and contact children’s caregivers, alerting them on the need to return to the clinic for ART. We will also increase routine viral load testing and provide support for HIV-associated developmental and psychosocial issues.

ART adherence improves significantly if children and their caregivers understand essential information about HIV and treatment, so we will provide clear and direct health messages that include pictures and other visual aids. Barriers like transportation costs and long clinic wait times can also make it difficult to stay in ART care. To help address these issues, we are piloting a program to provide ART refills and counseling at homes and boarding schools.

Continuous learning

Achieving these ambitious goals will require effective, efficient and accurate monitoring and evaluation. We will learn about the impact of this work continuously by conducting targeted evaluations on HIV testing, linkage to care and health outcomes.

Lessons learned from this innovative program will provide valuable information on providing comprehensive care to children and adolescents living with HIV – a critical component of both the Kenyan and global efforts to end the HIV/AIDS epidemic by 2030.

For more information, contact Dr. Craig Cohen.