Clinical Outcomes Among HIV-Positive Adolescents Attending an Integrated and Comprehensive Adolescent-Focused HIV Care Program in Rural Rwanda

Abstract

To serve the unique needs of HIV-positive adolescents, an adolescent-focused HIV program, which included clinical, psychosocial, and community-based services, was established in rural Rwanda. From October 1, 2009, to February 1, 2011, 206 HIV-positive adolescents aged 11 to 19 years were enrolled, of whom 10 transferred care out of the program. Overall, 191 (97.5%) of 196 adolescents were retained, 4 (2%) were lost to follow-up, and 1 (0.5%) died. Median follow-up time was 4.6 (interquartile range 3.2 to 5.7) years. Among 124 patients on antiretroviral therapy (ART) for at least 1 year, median CD4 increase was 347 cells/mm³(36 to 553), and 87% achieved virologic suppression (<500 copies/mL). Clinic attendance was high, with 90.8% and 88.5% of ART-initiated and pre-ART patients, respectively, attending the clinic within 90 days of the end of the follow-up period. Our findings suggest that integrated, comprehensive, and youth-friendly clinics for HIV-positive adolescents can be successful in rural, resource-poor settings.

KEYWORDS:

• adolescents
• psychosocial intervention
• Africa
• program evaluation
• counseling
• treatment retention
• viral load

ACKNOWLEDGMENTS

We would like to acknowledge the leadership and commitment of the Government of Rwanda, and the clinical staff and management of the Rwinkwavu and Kirehe District Hospitals for facilitating the establishment and activities of this innovative clinic. We would also like to thank the patients, families, and community health workers, who are the true inspiration for these efforts.

Notes

^a Excludes 10 patients who transferred care out of the program.

^b Unless otherwise noted.

Emily Merkel and Neil Gupta contributed equally to this article.