The Status of Adolescent Testing and Treatment in PEPFAR-Supported Programs, October 2017 to September 2020

Area of Science:

• Global Health
• Infectious Diseases
• Adolescent Health

Background:

• Adolescents face greater challenges in HIV care compared to adults.
• The US President's Emergency Plan for AIDS Relief (PEPFAR) supports HIV programs globally.
• The COVID-19 pandemic impacted healthcare delivery and HIV services.

Purpose of the Study:

• To evaluate progress in HIV case finding, antiretroviral treatment (ART) initiation, viral load coverage (VLC), and viral load suppression (VLS) among adolescents in PEPFAR programs.
• To assess these outcomes over a three-year period, including the onset of the COVID-19 pandemic.
• To identify areas for improvement in adolescent HIV care within PEPFAR-supported settings.

Main Methods:

• Analysis of PEPFAR program data from 28 countries/regions for adolescents aged 10-19 years.
• Data collected across three years: Year 1 (Oct 2017-Sep 2018), Year 2 (Oct 2018-Sep 2019), and Year 3 (Oct 2019-Sep 2020).
• Calculation of key indicators: HIV testing numbers, positivity rates, ART linkage, VLC, and VLS.

Main Results:

• HIV testing and positive case finding decreased between Year 1 and Year 3.
• Adolescent positivity rates increased slightly from 1.3% to 1.6%.
• Significant improvements were observed in ART linkage (77.8% to 86.7%), VLC (69.4% to 79.4%), and VLS (72.8% to 81.5%).

Conclusions:

• PEPFAR programs have successfully expanded the adolescent ART cohort.
• Gaps remain in adolescent HIV case finding, linkage, VLC, and VLS.
• Strategic testing, optimized ART regimens, and adolescent-focused models are recommended to address these gaps.