Improving Viral Load Suppression for Pediatric and Young Adolescent Clients
Improving Viral Load Suppression for Pediatric and Young Adolescent Clients
A Data Use Story from Taraba, Nigeria - By Ishaq Gidado
Introduction & Context
To achieve and sustain HIV epidemic control, it is paramount to attain sustained viral load (VL) suppression. In Nigeria VL suppression is generally defined as having fewer than 1000 copies of HIV per milliliter of blood. VL suppression is a key factor in averting advanced HIV complications, mitigating opportunistic infections, and curbing viral transmission.
VL suppression is especially difficult to achieve among pediatric and young adolescent clients (ages 0-14 years). In one State within Nigeria, Taraba, the VL suppression rate among these clients was 83% in September 2022, much lower than that of the general population (adult and children) rate of 93%. Despite persistent challenges, through targeted and sustained data use initiatives, it is possible to make rapid progress in pediatric and young adolescent VL suppression.
Taraba State is a largely agricultural area in northeast Nigeria with a population of around 2,300,000 and a 2.9% HIV prevalence rate (based on the National HIV/AIDS Indicator and Impact Survey [NAIIS – 2018]), with a spectrum estimate of around 47,000 people living with HIV. It has 29 health facilities across 16 local government areas that provide comprehensive antiretroviral therapy (ART) services with support from the U.S. President’s Emergency Plan for AIDS Relief.
Despite ambitious targets and long-running support from the Nigerian government and implementing partners, an analysis in late 2022 revealed that Taraba’s VL suppression rate among these vulnerable populations was at 83%, far short of the 95% target set for 2030 by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The data further showed that only two out of 29 health facilities in Taraba that provided ART achieved a suppression rate of 95% or higher. The other 27 facilities have VL suppression rates that range between 40-94%.
Identifying Root Causes & Effective Solutions
In response to this pressing challenge, a situation room meeting held in September 2022 and supported by the United States Agency for International Development convened to strategize on bolstering VL suppression rates among pediatric and young adolescent clients.
During this meeting, stakeholders and implementing partners delved into the root causes behind the rates, pinpointing several contributing factors across Taraba State. These included:
Non-aligned strategies by different partners
Ineffective efforts promoting adherence clubs
Varied focuses in pediatric meetings
Inadequate tracking of clients with low adherence, and
A lack of peer involvement in promoting ART adherence
Once these root causes were identified, solutions were crafted and implemented. Namely:
The State Ministry of Health initiated monthly meetings to align partner strategies effectively.
The State Ministry of Health initiated monthly meetings to align partner strategies effectively.
The Data for Implementation (Data.FI) project helped to enhance the data review process, strengthening the skills and data use capacity of the Taraba technical working group on VL suppression.
Adherence champions were nominated within existing adolescent and young adult (0-24 years) ART clubs that promote zero viral load, zero missed appointments, and zero missed drugs. These operation triple zero (OTZ) clubs.
Capacity-building sessions for case managers across supported sites improved the management of virally unsuppressed children.
Civil society organizations were engaged to coordinate and enhance pediatric and young adults' ART clubs under the OTZ initiative.
All of these strategies were designed to be fundamentally collaborative, working through Taraba partners and teams, to avoid an unsustainable reliance on external resources.
Impact & Conclusions
The collective efforts bore fruit: Between September 2022 and January 2023, the suppression rate experienced a steady climb, and since then the rate has held steady at around 92-93% (as of September 2023).
Suppression rates ranged from 64% during routine monitoring visits, to 71% at the start of the situation room discussions, and to 83% following major data review meetings. The determined approach taken during technical working group meetings and pediatric monthly meetings propelled the rate to an impressive 92%—a remarkable advancement, bringing the State much closer to the coveted UNAIDS 95% target in a matter of months.
The journey to elevate viral load suppression among pediatric and young adolescent clients in Taraba State exemplifies the power of strategic interventions and relentless determination.
Moreover, the experience in Taraba demonstrates that securing better HIV health outcomes for vulnerable populations is possible even in low-resource settings, when data use strategies are designed to meet specific local challenges and solutions are implemented through a collaborative network of government, health workers, and technical support.
Have any questions? Feel free to contact the author at: ishaqa.gidado@thepalladiumgroup.com