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High rates of acceptance and viral re-suppression among children and adolescents (0-19 years) receiving virtual enhanced adherence counselling and synchronous medication reminders in Nairobi, Kenya

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BACKGROUND: Emergence of the COVID-19 pandemic with guidelines for social distancing posed unprecedented challenges to HIV service delivery. Face-to-face directly observed therapy (DOT), for children and adolescents living with HIV (CALHIV) with high viral loads (HVL) could not be achieved. As an adaptation measure, we adopted phone based virtual enhanced adherence counselling (VEAC) and daily medication intake reminders for CALHIV with HVL in Nairobi. We describe program level experience, acceptability and re-suppression rates among CALHIV receiving VEAC and daily reminders between May-September 2020.
DESCRIPTION: We implemented VEAC and daily medication reminders in 18 University of Maryland supported government facilities in Nairobi. We developed standard operating procedures, trained healthcare workers on VEAC implementation and provided phones to facilitate this process. We sought written consent from caregivers and allowed them to participate in choosing their preferred case-managers. Phone alarms were aligned for clients and case-managers to the time of taking medication. Case-managers conducted daily calls at the time of medication intake to confirm drug intake. Adherence counsellors called caregivers 2 weekly for VEAC. We evaluated their viral load outcomes as at the end of 3 months of VEAC.
LESSONS LEARNED: We conducted a retrospective analysis of children and adolescents (0 -19years) with HVL between May and September 2020 in 18 facilities in Nairobi who had been initiated on VEAC. Among 152, 121 (80%) accepted and were offered 2 weekly VEAC and daily medication intake reminders. All the 121 (100%) were active by month 3 of follow up. 93 (77%) had completed 3 months, 68 (73%) had a repeat viral load and 58 (85%) had viral load results documented. Two-thirds (67%) re-suppressed without regimen switch (54% among the 0-4,71% 5-9,75% 10-14 and 67% 15-19). Re-suppression was lowest among the 0-5. The primary problems encountered were unresolved client adherence challenges, inconsistent reach over the phone & delay in viral load results.
CONCLUSIONS: There is high acceptability of VEAC and daily phone- based reminders. Implementation of this strategy resulted in high re-suppression and retention of CALHIV with HVL. HIV programs need to consider implementation and scale-up of this strategy in order to fast-track achievement of the 95-95-95 targets for CALHIV.