Excellent healthcare – locally delivered Stepping up the pace of HIV prevention, testing, treatment and care for ADOLESCENTS in the African region: Outcomes Dr Teshome Desta Woldehanna Child and Adolescent Health Inter-Country Support team, East and Southern Africa, World Health Organisation Regional Office for Africa

Adolescent HIV Issues Most adolescents do not know their HIV status Over 80% of all ADLHIV are in African Region AIDS related deaths are declining in all age groups except in Adolescents

Regional Workshop Aim: To review progress in countries, and develop or refine country roadmaps to improve and accelerate progress on paediatric and adolescent HIV Objectives: To take stock of progress against implementation of guidelines and identify challenges, gaps and bottlenecks as well as priority actions to accelerate To build a shared understanding of findings and the methodology of recent assessment of national HIV programmes To provide technical updates on guidance on innovative approaches, services delivery models and prevention interventions To develop short and medium-term plans of actions for implementation at country level. Convened 14 countries in AFRO with high HIV prevalence rates

Workshop Approach

Monitoring and Evaluation – Data collection and management systems – Lack of age disaggregation and tools to implement – Lack of effective use of data for quality improvement and planning – Lack of systems to track community based interventions Laboratory capacity – Stock out of test kits – Long turn around time HCW confidence and skills – Attitudes towards adolescents – Training in skills around adolescents Consent and legislation – Age of consent – Harmonizing health and all relevant legal instruments and policies Regional outcomes of preparatory work Key Issues -1

Collaboration and coordination – Within MoH, other sectors, communistes and among implementers Policies, strategies, Guidelines, plans – Limited operationalization for adolescents – Lack of policy for integration of Adolescent HIV within MCH/Adolescent health – Lack of national guidelines that takes into account country context Service delivery – Linkage and referral – Lack of meaningful engagement of adolescents – Retention and loss to follow up – Integration in existing or alternative service delivery platforms Stigma – Adolescents with HIV, pregnant girls and young mothers. Regional outcomes of preparatory work Key issues -2

Promising innovations for improving Adolescent HIV mHealth & community based initiatives  One2one in Kenya - An Integrated Digital Platform which is a peer led innovative & evidence based programme offering comprehensive knowledge on SRH/ HIV/ GBV services & literacy to adolescents & youth >1million  B-wise in South Africa :Adolescent & Youth Health mobile website that addresses knowledge gaps amongst young people years.  Launched in Aug ,070 users  Peer based interventions: Zvandiri Community Adolescent Treatment Supporters – Zimbabwe.

Prevention – Scaling Up Comprehensive Sexuality Education – focus on capacity strengthening and delivery – Engagement of adolescents – through traditional, social media and ICT to support HIV prevention, treatment adherence and social change – Improving service access through national policy, guidance and training – focus on enhancing quality of response and services for adolescents – Optimize reaching adolescents through implementation and revitalization of school health programmes – integrate age-appropriate intervention and information in school health package Stepping up interventions for adolescents

Testing – Review existing policies and laws and advocate for harmonizing the age of consent for testing – Review/adapt WHO Adolescents HTS Guidelines and key SOPs – Community engagement to increase knowledge on CSE, HIV, HTS and treatment – Maping high yield sites and use available structures to reach out to adolescents ( families, churches, schools, youth networks, mHealth ) – Promote specific days and times for adolescent in schools to come to clinics for HTS. – Advocate for increase in domestic funding for HTS. Stepping up interventions for adolescents

Optimizing ARV Treatment for Adolescents – Strengthen comprehensive client centred care – Integration and linkages – Task sharing – Strengthen Healthcare workers training, mentorship and supervision – Innovations - Use of SMS to remind adolescent if they’ve missed their appointments and Link ePMS with SMS alert or reminders for follow up and adherence Stepping up interventions for adolescents

Service delivery across the continuum-1 – Coordination, planning and monitoring: Make adolescents part of the cluster coordination meetings, facilities meetings and Ward AIDS Committees in the community levels. – Define the minimum package of services at various levels – Develop/adapt guidelines, tools and checklists for service integration (MNCH, FP & ART) – Expand service delivery points and promote various service delivery models – Establish /scale up Adolescent and Youth Friendly services Stepping up interventions for adolescents

Service delivery across the continuum-2 – Psychosocial Support - Build capacity of support groups and develop guidelines and job aids – Capacity building through pre and in-service training to improve provision of care to adolescents – Guidance on linkages on ALWHIV to other health facilities services Stepping up interventions for adolescents

Community engagement and adolescent participation – Adolescent participation in coordination, planning and monitoring – Capacity building of community support groups: Identify support groups and available platforms in the community and build their capacity to support ASRH/HTS – Establish/strengthen partnerships: CSOs, NGOs, CBOs, Networks to render ASRH/HTS – Develop packages for peer support for adolescents – Scale up community intervention models nationwide

Stepping up interventions for adolescents Cross cutting themes – Review and update available M and E tools to capture strategic information – Harmonization of registers, reporting tools etc – Capacity building for improved quality of reporting with age disaggregation and use – Develop SOPs for health facility, district, provincial and national data audit review – Develop a target setting framework for adolescents

Supporting the pace Support finalisation of the roadmap (10 of 14 countries have shared their updated road map) Support leveraging partnerships and resources ( initiatives and opportunistes such as All in, GF, The ELMA foundation, PEPFAR/DREAMS; IATT, GFF) Provide technical support to operationalize the roadmap Monitoring progress

Many Thanks Country teams WHO and UNICEF country offices WHO and UNICEF HQ and Regional Offices