PATA 2019 Summit: Day 1 | Integration with SRHR for Adolescents

Selected Q&A

Questions asked by webinar attendees but not covered in the live Q&A session due to time constraints are included below with comments from our presenters. Please note that this section will be updated with additional questions in the next week. 

To MSF, the viral load suppression rates of 98% are excellent. What is the cost for implementing this strategy?

Pumeza: For this programme, we have not had to bear much cost at all. We are working with the Department of Health and all parts of the programme are done within the facility. The staff and counselors are all from government or from NGOs that are already working in the facility. We are building on resources that already exist. Our costs are limited to things like printing session guides and even for that, we liaise with the government printing office. The venue for the community club is a town hall so that also does not have a specific costs.

When we wanted to start the clubs, we had engagements with the community itself, so that there was an understanding that this programme is not coming from any organization but from young people living in the area. The facilities have community advisory boards that are made up of community leaders who look at what the facility does and link those efforts with the community. It’s a largely no-cost effort that builds on existing resources.

What have you found missing in health workers' pre-service curriculum on adolescents living with HIV and adolescent health in general?

Violet: The regular training curriculum includes comprehensive management of HIV, which mostly addresses the care of adults and children. There is a special package for health workers who are in-service on adolescent HIV management and care. I think this really needs to be incorporated as a special package because it’s still a big challenge even for those who have been in-service. Adolescents are often treated as big children or little adults. This comprehensive adolescent package is important to deliver good service to this population.

What is your experience in transitioning adolescents living with HIV to adult care?

Violet: The challenge we see in Mildmay is that the adolescents have deep attachments to health care providers. They were often with us as children and had relationships with the providers in the children’s clinic. When they grew into adolescence, they attend the youth center (KYC), where they then built trust and close relationships with those health care providers. The transition to adult care is difficult because the young adults feel like they’re being thrown in murky waters and are losing those clinicians they’ve known so far. So what we have tried to do is have a specifically trained clinician on the adult side who receives them on the first day of transition and eases them into the new programme.

Another challenge that these young adults face is that the way they dress and the language they use is very different from those at the adult clinics, so this also makes the experience even less comfortable for them. Because of this, we sometimes have issues with people continuously cancelling appointments when they reach 20 years of age in order to avoid transitioning. One strategy we have been using to mitigate this is to start prepping adolescents from age 17 years onwards about transition with counselling.

What is a good approach to reach older partners of adolescents girls? Sometimes, index testing can be difficult because adolescent girls hide their partners due to legal penalties the older partner might face.

Pumeza: It’s really an issue of building trust with the adolescent girls. If they are able to give us the contact, we shall use assisted partner notification to track the partner. And then we don’t have to delve into the issue of penalties because we are assisting. Assisted partner notification is a good approach if we can build trust with the girl to be able to give us more information; we can then bring the partners into care if needed.

Violet: In Uganda, there is an organization that does door-to-door HIV testing. Their approach is to track all the partners of those who test positive and the sexual partners of each of these contacts. In the community clubs, we often encourage everyone to bring partners – we don’t disclose HIV status there but will just use it as a place to share information. We provide education and referrals. The male service clinics will test the partners regardless of age.

To follow-up on the presentation from Uganda, do you do mental health assessments?

Violet: We do mental health assessments and have a resident psychiatric officer. We also do referrals for specialized psychiatric services when needed.

To the presenter from MSF: are the adolescents referred to receive a pap smear at the health facility or does it take place at the community hall. If it takes place at the community hall, what steps are taken for privacy and hygiene?

Pumeza: We do pap smears only in the health facilities. There are special days when participants meet in the health facility rather than the community hall; there, they get pap smears and refills. There are no additional sessions on those days. There are other services done in the community hall itself: bloods, family planning, clinical visits, some STI screening and treatment.

Are the basic screening free for the adolescents?

Pumeza: Yes, the basic screening is free for adolescents.  

Violet: The services are free in most government-aided facilities. At Mildmay, in addition to the basic STI screenings, cervical cancer screening is also free for adolescents.