Impact of a teen club model on HIV outcomes among adolescents in rural Neno district, Malawi: a retrospective cohort study

Abstract

Objective To compare the impact of a teen club model to the standard care model on HIV treatment outcomes among adolescents (10-19 years of age). Design Retrospective cohort study. Setting HIV clinics in Neno district, Malawi. Participants Adolescents living with HIV enrolled in teen clubs (n=235) and matched participants in standard HIV care (n=297). Outcome measures Attrition from HIV care, defined as a combination of treatment outcomes 'died', 'defaulted' and 'transferred out'. Results Over a 4-year follow-up period, adolescents who participated in the teen club had a significantly higher likelihood of remaining in care than those who did not (HR=2.80; 95% CI: 1.46 to 5.34). Teen clubs also increased the probability of having a recent measured viral load (VL) and BMI, but did not change the probability of VL suppression. The age at antiretroviral treatment initiation below 15 years (aHR=0.37; 95% CI: 0.17 to 0.82) reduced the risk of attrition from HIV care, while underweight status (aHR=3.18; 95% CI: 1.71 to 5.92) increased the risk of attrition, after controlling for sex, WHO HIV staging and teen club participation. Conclusions The teen club model has the potential to improve treatment outcomes among adolescents in rural Neno district. However, in addition to retaining adolescents in HIV care, greater attention is needed to treatment adherence and viral suppression in this special population. Further understanding of the contextual factors and barriers that adolescents in rural areas face could further improve the teen club model to ensure high-quality HIV care and quality of life.