1. Jepkoech Kottutt1, Emilia D. Rivadeneira2, Susan Hrapcak2
Review of Policies Guiding the Adolescent HIV Care Continuum in 16 sub-Saharan African Countries
Jepkoech Kottutt1, Emilia D. Rivadeneira2, Susan Hrapcak2
1Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
2Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
22nd International AIDS Conference (AIDS 2018)
Amsterdam, Netherlands | July 2018 RAI Amsterdam Convention Centre
Center for Global Health

2. AIDS-Related Deaths Among Adolescents
Background
Adolescence is a period of great growth and development.
Globally, ~2.1 million adolescents years were living with HIV with a majority of them living in sub- Saharan Africa1.
AIDS-related deaths are steadily increasing among adolescents and it is the second highest cause of death within the sub-population globally.2
AIDS-Related Deaths Among Adolescents
AIDSinfo|UNAIDS (available online using
UNAIDS DATA 2017 (available online using
Image : Slogrove et al. JAIDS, (Suppl 3),

3. Background
Healthcare workers face challenges in provision of services to ALHIV as many are not comfortable working with adolescents1,2.
Kranzer K. et al. PLoS Med. 2014; 11:e
Phelps B. et al. AIDS. 2013;27(2):S
Image: Created from data included in Brown K et al. MMWR, 2018;67:29–32. DOI:

4. Background
The 2016 WHO consolidated guidelines were the first that identified adolescents as a separate population.
Countries have also recognized the need for adolescent-targeted policies and services.
Goal: This policy review assessed 16 PEPFAR-supported, sub- Saharan African countries for inclusion of policies and recommendations targeting adolescents within national HIV/ART and HIV testing guidelines.
Image:

5. Methods
Policy review of publicly available national HIV/ART and HIV testing guidelines in English.
5 thematic areas in which data were collected and assessed include:
Frequency of HIV testing in sexually active adolescents
Recommended age of full disclosure
Age of consent for treatment initiation
Frequency of routine viral load (VL) in adolescents
Recommended age for transition from adolescent to adult services
Policies for adolescents living with HIV (ALHIV) along the HIV care continuum were abstracted, entered to a database and assessed.
Analysis was performed using Microsoft Excel.

6. Results
*Kenya was the only country whose guidelines included all 5 thematic areas assessed.
Inclusion of the Adolescent HIV Care Continuum in National HIV/ART Guidelines in 16 countries in sub-Saharan Africa
Recommendation
Countries Included %
Frequency of routine viral load (VL) in adolescents
Botswana, Cameroon, Kenya, Lesotho, Malawi, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe
94%
Frequency of HIV testing in sexually active adolescents
Kenya, Lesotho, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia
50%
Disclosure
Cameroon, Ethiopia, Kenya, Lesotho, Namibia, Rwanda, Tanzania, Zambia
Age for transition from adolescent to adult services
Kenya, Namibia, Uganda, Zambia
25%
Age of consent for treatment initiation
Kenya, Rwanda, Swaziland
19%

7. Results: Knowing your HIV Status (1st 90)
Frequency of HIV Testing in Sexually Active Adolescents
Disclosure
WHO
No explicit recommendations
Country
Guidelines
Included in 8 guidelines (50%)
Examples
Annual testing (n=6)
Every 3-6 months (n=1)
Every 6-12 months( n=1)
WHO
Children of school age (6-12 years)
Country
Guidelines
Included in 14 guidelines (88%)
8 included recommended age of full disclosure (50%)
Examples
8-10 years; years; years; years; 13 years (n= 1 for each)
≥10 years (n= 3)

8. Results: Treatment Initiation (2nd 90)
Age of Consent for Treatment Initiation
Transition from Adolescent to Adult Services
WHO
No explicit recommendations
Country
Guidelines
Included in 3 guidelines (19%)
Examples
12 years (n=3)
WHO
No explicit recommendations
Country
Guidelines
Included in 7 guidelines (44%)
Only 4 included a recommended age (25%)
Examples
Kenya (19 years)
Namibia (15-19 years)
Uganda (20 years)
Zambia (16-19 years)

9. Results: Viral Suppression (3rd 90)
Frequency of Routine VL in Adolescents
WHO
Performed early after initiating ART (within 6 months), at 12 months and then at least every 12 months to detect treatment failure.
Country
Guidelines
Included in 15 countries (94%)
9 followed WHO recommendations (56%)
5 recommended more frequent VL due to higher rates of virologic failure (31%); 1 recommended less frequent VL
Examples
Botswana, Cameroon, Namibia, Swaziland and Uganda (every 6 months)
Malawi (every 2 years)

10. Limitations Limited to English-language guidelines
Did not include supplemental materials
Did not include laws or policy amendments
Limited to ART/HIV and HIV testing guidelines

11. Gaps in Policy/ Recommendations
Conclusions
There is currently a wide variability in national HIV/ART guidelines to address the unique needs of ALHIV
Variability
Not all guidelines provide guidance on the 5 thematic areas, which may affect adolescent service provision by healthcare workers (HCWs)
Gaps in Policy/ Recommendations
More specific guidance should be included in national guidelines for HCWs to provide appropriate adolescent-friendly HIV services to improve clinical outcomes in ALHIV
Recommendation

12. Acknowledgements Susan Hrapcak, MD Emilia D. Rivadeneira, MD
Pediatric and Adolescent HIV Team, Maternal and Child Health Branch, Division of Global HIV & TB

13. Thank you!
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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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