Optimizing antiretroviral treatment and viral suppression for adolescents and young people living with HIV by implementing Operation Triple Zero (OTZ) in four states in Nigeria

BACKGROUND: In Nigeria, adolescents (10-19 years) account for about 23% of the total population, and 7% of people living with HIV (PLHIV); treatment outcomes for adolescents and youth living with HIV (AYPLHIV) are quite low. RISE-Nigeria commenced Operation Triple Zero (OTZ) in 33 facilities across four states in February 2020 to improve treatment outcomes. This analysis reviews the effect of OTZ on treatment outcomes among AYPLHIV six months after implementation.
DESCRIPTION: The OTZ model focuses on health system modifications, adolescent-centeredness and involvement in health, and education of caregivers and health workers. Case managers were identified and trained on non-judgmental approaches to counselling and optimal antiretroviral therapy (ART) for AYPLHIV; Clinic settings modified with adolescent-friendly themes; all services integrated and systems for peer-to-peer adherence support strengthened; Extended and weekend clinic hours established, with an appointment system for age bands 10'14, 15-19 and 20'24 years; Viremia clinics established for the virally-unsuppressed AYPLHIV; Case-based learning introduced for capacity building of health workers; Talent nurturing and skill development incorporated into AYPLHIV club meetings; and HIV status disclosure support offered to caregivers with opportunity for caregivers interaction during OTZ meetings facilitating peer-to-peer learning.
LESSONS LEARNED: After 6 months, AYPLHIV enrollment into OTZ increased from 615/3306 (18.6%) to 3595/4304 (83.5%); p-value <0.001. Optimal regimen utilization pre-intervention was 284/765 (37.1%%), 285/760 (37.5%), and 709/1526 (46.5%) preintervention, and increased to 807/819 (98.5%), 985/991 (99.4%), and 2478/2484 (99.8%); p-value <0.001 post intervention for age bands 10-14, 15-19, 20-24 years respectively. Viral load coverage (VLC) was 255/765(33.3%), 230/761(30.2%), 492/1772(27.7%) pre-intervention and increased to 740/819(90.1%), 806/991(81.3%) and1794/2484 (72.2%); p-value <0.001 in respective age bands post-intervention. Viral suppression (VS) rate increased from 390/586(66.6%), 286/552(51.8%) and 1155/1690(68.3%) pre-intervention to 611/749 (81.6%), 700/844(82.9%), and 2030/2384(85.2%); p-value<0.001 in respective age bands post-intervention. Overall VS was higher 2487/2935 (84.7%) among OTZ enrollees compared to non-enrollees 852/1040 (81.9%); p-value 0.03.
CONCLUSIONS: OTZ implementation improved the use of optimal ARV regimen, VLC, and VS among AYPLHIV. These results validate the use of integrated, asset-based strategies to improve HIV treatment outcomes among AYPLHIV.