Transcript Slide 1

Impact of implementing “adolescentfocused” 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, “youthhostile” 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 ‘adolescentfocused’ 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
Figure 1. HIV Diagnoses Among Adolescents at GHESKIO: 1983 - 2013
800
Number of HIV Diagnoses in Adolescents
700
600
500
400
300
200
100
0
1983
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1993
2003
2013
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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