The design, implementation, and effectiveness of teen models of care: lessons from MSF supported programmes providing treatment and care for adolescents aged 10 to 19 living with HIV in Malawi and Uganda

This “lessons learned” report presents a thorough documentation of the implementation process of the models of care for adolescents (aged ~10-19 years) living with HIV (ALHIV) in two HIV programmes supported by MSF. The first is in Arua, a town in the West Nile Province in Uganda and, the second, in Chiradzulu rural district, Southern Malawi. Both countries are among the top 15 countries to be affected by HIV in the world. Whilst Arua is in a lower HIV-prevalent setting, Chiradzulu district remains one of the most affected regions of Malawi.

The key lessons learned from this implementation were:

▸ Schedule all adolescents on the same day(s); preferably during out-of-school hours.
▸ Ensure disclosure is a repeated and ongoing process and not an on/off one.
▸ Maintain close collaboration between clinicians and counsellors to continuously transmit information to the changing and evolving concerns of teens.
▸ Organize sessions by age band, separating the pre-pubescent adolescents from older ones. Full HIV disclosure is recommended before integrating the adolescents into group activities.
▸ Include sexual and reproductive health in the package of care. Health workers and peers must be trained to address the specific concerns of adolescents.
▸ Recognize peers are an important asset to conveying messages and sharing positive experiences. While peers are useful actors in the management of teens, they should not be solely responsible for managing the cases of adolescents failing on treatment.
▸ Perform a viral load (VL) every six months for this vulnerable age group. Point-of-care VL, with same-day results, permits a rapid management of the unsuppressed patients, and requires logistic organization in rural contexts.
▸ Utilize a multidisciplinary team – clinicians, counsellors, psychologists, social workers, and peers – to address the complex situations faced by some adolescents.