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Improving Adolescent HIV Services in Haiti: Impact of Adolescent-Focused Care

This study explores the implementation of adolescent-focused HIV services in Haiti, addressing critical barriers that hinder diagnosis and treatment of HIV in youth. With over half of new infections occurring in adolescents and significant issues with adherence to ART, targeted interventions were vital. The establishment of the country’s first adolescent HIV clinic and a community advisory board led to a substantial increase in diagnosed adolescents from ~100 in 1993 to ~700 in 2013. Key improvements included higher ART adherence rates, reduced mortality, and decreased rates of unwanted pregnancies over a five-year period.

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Improving Adolescent HIV Services in Haiti: Impact of Adolescent-Focused Care

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  1. Impact of implementing “adolescent-focused” services in Haiti Rachel Bertrand MD , Lindsey Reif MPH, Serena Koenig MD, JW Pape MD

  2. 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

  3. 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

  4. 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)

  5. 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).

  6. Results • Over 80% of those diagnosed are young women. • After 5 years of operating the Adolescent HIV Clinic: • ART adherence rates :45% to 70%, • mortality : 13% to 7%, • unwanted pregnancies: 25% to 8%.

  7. Impact of implementing “adolescent-focused” services in Haiti

  8. 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.

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