www.aids2014.org impact of implementing “adolescent- focused” services in haiti rachel bertrand...
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www.aids2014.org
Impact of implementing “adolescent-focused” services in Haiti
Rachel Bertrand MD , Lindsey Reif MPH, Serena Koenig MD, JW Pape MD
www.aids2014.org
Background
• Half of all new HIV infections
• High risk for failing to initiate treatment and adhere to ART.
• More than 50% of adolescents on ART had a drug resistant virus and were not considered adherent to treatment. (GHESKIO/Port-au-Prince)
• Only 20% of HIV-infected youth are disclosed
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Background
• Barriers to HIV testing : low perception of personal risk, fear of stigma, “youth-hostile” clinic environments, and lack of provider-initiated HIV testing when youth seek medical attention.
• Majority of HIV-infected adolescents : not disclosed , unprotected sexual intercourse, late for appointment , increase of morbidity and mortality
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Methods
• Need to improve prevention and treatment in this vulnerable population
• Developed and implemented ‘adolescent-focused’ services
• Country’s first Adolescent HIV Clinic
• Creating the first adolescent community advisory board (CAB)
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Results
• Increased the amount of HIV-infected adolescents diagnosed.
• Over the last 20 years, 7-fold increase in the number of HIV-infected adolescents ages 15 – 24 years diagnosed
• Rising from ~ 100 HIV-infected adolescents diagnosed in 1993 to ~700 in 2013 (Figure 1).
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Results
• Over 80% of those diagnosed are young women.
• After 5 years of operating the Adolescent HIV Clinic:
1. ART adherence rates :45% to 70%,
2. mortality : 13% to 7%,
3. unwanted pregnancies: 25% to 8%.
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Impact of implementing “adolescent-focused” services in Haiti
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Figure 1. HIV Diagnoses Among Adolescents at GHESKIO: 1983 - 2013N
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Conclusions
The next step is to develop a standard protocol for adolescent HIV services that can be scaled-up as the standard of care in HIV clinics throughout Haiti.