Retrospective Cohort Study Comparing Antiretroviral Treatment Outcomes Among Adolescents in Teen Clubs and Standard Care Clinics: Blantyre, Malawi

Abstract

Introduction: This study investigated if the Teen Club model improves virological suppression and reduces virological failure. Viral load monitoring is a golden ART programme performance indicator. HIV treatment outcomes are poor among adolescents compared to adults. Different service delivery models are being implemented to address this; among them is the Teen Club model. Currently, teen clubs improve treatment adherence (short-term impact), but there is a knowledge gap regarding the long-term impact. The study compared the rate of virological suppression and failure among adolescents in Teen Clubs and those on the standard of care (SoC) model. Methods: This was a retrospective cohort study. A total of 110 adolescents in teen clubs and 123 adolescents in SOC from six health facilities were selected using stratified simple random sampling. The participants were followed for 24 months. STATA version 16.0 was used for data analysis. Univariate analyses were performed for both demographic and clinical variables. A Chi-squared test was used to assess the differences between proportions. Crude and adjusted relative risks were calculated using a binomial regression model. Results: At 24 months, 56% of adolescents in the SoC arm had viral load suppression compared to 90% in the Teen Club arm. Of those who achieved viral load suppression at 24 months, about 22.7% (SoC) and 76.4% (Teen Club) achieved undetectable viral load suppression rates. Adolescents in the Teen Club arm had a lower viral load than those in the SoC arm (adjusted RR 0.23, 95% CI: 0.11-0.61; p = 0.002 adjusted for age and gender). Teen Club and SoC adolescents had virological failure rates of 3.1% and 10.9%, respectively. The adjusted RR was 0.16, 95% CI: 0.03-0.78; p = 0.023; those in Teen Clubs were less likely to have virological failure relative to those in SoC after adjusting for age, sex, and place of residence. Conclusion: The study found that Teen Club models are more effective at achieving virological suppression among HIV positive adolescents.