HIV: Family based approach, identification point for adolescents
To intensify HIV response for adolescents and young people, a new project is using family based and index case finding approaches as an entry point to identify adolescent and young people, AYP, living with HIV in Lagos state.
The project was initiated in response to the 2016 National Adolescents and Young Peoples HIV strategy, as Nigeria is home to 10 per cent of Adolescents Living With HIV, ALHIV, about 240,000.
However, this number is not reflected in HIV Testing Services, HTS, and Anti- Retroviral Therapy, ART, services, hence, the need to find these adolescents living with HIV and put them on treatment.
It also seeks to observe and document factors that facilitate successful scale - up in identification and treatment of AYP living with HIV in service programmes in three states in Nigeria including Lagos.
However, the study uses family based and index case finding approaches as an entry point to identify AYP aged 10-24 years, through family attending HIV treatment sites, as well as support groups and Orphan and Vulnerable Children, OVCs, programmes.
These approach will help determine the HIV prevalence of 10-24-year-old AYP recruited through family attending treatment and support sites; and ascertain predictive factors for identifying AYP living with HIV who were recruited through family attending HIV treatment and support sites within the state.
At a recent event in Lagos by the State Aids Control Agency, LSACA, in collaboration with Positive Action for Treatment Access, PATA, and United Nations Children's Fund, UNICEF, Mrs. Victoria Isiramen, a UNICEF HIV Specialist said, "young people are the present, and we need to engage them. Many say it is not easy finding young people. Maybe because they do not come out.
"The index finding is a way of identifying adolescents with this virus and putting them on treatment. This work was done in Benue, Federal Capital Territory and now Lagos.
"UNAIDS believes that our children should be born free and live free of HIV, and promise to give in our best. It is identified that we have more females with this virus than males."
Isiramen said the partnership keeps HIV response for adolescents and young people in focus and together we can find and save adolescents and young people living with HIV, what we are doing is to ensure that they have a friendly and welcoming service so as to keep preventing this ailment.
She stated the index case as follows; 8,525 index cases were identified, 105 known positives, 42 per cent aged 10-14 years old tested positive, 10156 adolescents and young people traced and tested, 36 per cent adolescents and young people tested positive.
She added that 50 per cent aged 10-14 years tested positive and 8 percent adolescents and young people aged 20-24 years tested positive.
The UNICEF HIV Specialist said the index adult cases were identified through support groups and antiretroviral clinics located in public health facilities.
She said while the index sibling cases were identified through the ART clinics and, OVCs programmes run by non-governmental organisations located in Lagos state.
Isiramen said that the index-case finding tool was used to collect details of children and AYP in the care of the index adults and index siblings.
She, however, said that the National Client Intake Form was administered to children and AYP identified through the index cases that were tested for HIV through this project, adding that a questionnaire was also administered to the AYP identified, to assess their socio-demographic information, sexual behaviour and practices.
According to her, "data collection was monitored to assure quality. Data was analysed to determine the HIV sero-discordancy rate; differences in HIV sexual risk behaviour and practices of HIV-positive and HIV-negative AYP; and predictors for HIV positivity.
"Ethical clearance of the study was obtained from the Nigeria Institute of Medical Research Institutional Review Board."
Making his presentation, Isaac Moses in a Project Review of PATA, said that, "it was found that index case finding was more efficient for recruiting children and younger adolescents than older adolescents and young persons.
"That the approach increased the number and proportion of AYP accessing HIV testing and ART services at facilities. A large proportion of children and siblings 57.3 percent of index cases did not know their HIV status."
Moses said 36 HIV positive AYP were identified, equally spread between males and females.
He said, study also found a proportion of wards/children of index cases practicing unprotected vaginal sexual intercourse.
Significantly, he said, more HIV-positive than HIV-negative AYP use condoms during vaginal sexual intercourse.
Moses said "the highest rates of HIV positivity yield was found within the AYP aged 10-14 year-old: 42 percent. In the overall study, as high as 5.7 percent of HIV-negative AYP are eligible for Pre -Exposure Prophylaxis, PrEP."
On recommendations, Moses said the study posits that index case finding through family approach is an efficient way of generating high yield rates for HIV testing for AYP.
He said that targeted HIV testing of AYPs who are married, have a positive history of sexually transmitted infection, symptoms of tuberculosis, aged 20-24-year-olds will likely yield high HIV positivity rates.
He states that, "when index case finding approach is to be used; recruitment of the first to fourth children of index cases will likely yield more HIV positivity cases.
According to the recommendation, Access to PrEP needs to be prioritised for sexually active HIV-negative AYP.
Further studies need to be conducted to learn how to best reach HIV-positive AYP through messaging on protected sexual intercourse, the value of accessible treatment, viral suppression, and non-transmission of HIV infection.
However, the studies should also include filter questions, as non-respondents to questions on age of sexual debut and history of sexual intercourse are more likely to have high risk sexual behaviour, or a history of sexual assault.