BACKGROUND: In South Sudan, viral suppression (VLS) for children and adolescents living with HIV (CALHIV) 0-17 years is 63%. Factors contributing to low VLS include missed appointments, non-adherence to treatment, lack of psychosocial support and other community services, and stigma and discrimination. Adolescents and Children, HIV Incidence-reduction, Empowerment, and Virus Elimination (ACHIEVE), a USAID/PEPFAR funded project, is implemented in South Sudan by Jhpiego in collaboration with Ministry of Health (MOH) offering services to CALHIV in Juba County through community-based case management.
DESCRIPTION: ACHIEVE collaborates with health facilities where CALHIV are identified and offered enrolment into the orphans and vulnerable children (OVC) projects. Services are provided by case care workers and community adolescent treatment supporters (CATS). CATS update clinical records and work with clinical partners to ensure that non-suppressed CLHIV are identified and case conferenced, and action plans are designed and monitored until VLS is achieved. Families of CALHIV receive other services including HIV treatment literacy provided twice a quarter through home visits, disclosure counselling, reminders for clinical appointments, including for viral load testing and MMD, as well as economic strengthening services through savings groups for caregivers, income generating activities, positive parenting training, and education support for children.
LESSONS LEARNED: Between April 1, 2020, and December 2023, 542 CALHIV were enrolled in the OVC program (316F/226M). Viral load suppression (VL= 1000 copies/ml) among the CLHIV increased from 63.4 to 90 percent in this period. CALHIV who stayed longer in the OVC program achieved better viral suppression: 87 percent for 18 to 24 months compared to 70 percent for <6 months. These findings suggest length of time in the OVC program may be a predictor of improved VLS rates among CLHIV. The main barrier to viral suppression for CALHIV was interrupted adherence as a result of limited access to food.
CONCLUSIONS: Community-based services through the OVC platform offer an opportunity to provide family-centered services, bridging the treatment cascade gap and contributing towards sustained viral load suppression. ACHIEVE will build on these findings and best practices to strengthen coordination with MOH and clinical partners to enroll and offer OVC and other comprehensive services towards 95% VLS.