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�������Assessing the effects of Psychosocial interventions on clinical outcomes among adolescents enrolled in Teen-Club program at Lighthouse Trust-Tisungane�Brown Gagamsataye, Richard Mali, Tom Chaweza, Jacqueline Huwa, Gabriel Kamowatimwa , Christine Kiruthu-Kamamia

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Lighthouse Clinic Trust operates five large referral level HIV/TB clinics and supports smaller clinics in Lilongwe�

  • Lighthouse clinic Trust was founded in 2001, is funded by PEPFAR through CDC since 2003 and was recognized as Centre of Excellence for HIV care in 2004 by the WHO.
  • Currently Lighthouse Trust established Centres of Excellence in all Malawian referral hospitals:
    • Zomba Central Hospital (LH-Tisungane)-7,888
    • Kamuzu Central Hospital, Lilongwe (LH-KCH)-12,629
    • Bwaila Hospital, Lilongwe (LH-MPC)-24,887
    • Queen Elisabeth Central Hospital, Blantyre (LH-UFC)-16,643
    • Mzuzu Central Hospital (LH-Rainbow)-5,770
  • The Centres of Excellence had 67,817 recipients of care on ART and 20,085 in smaller supported clinics as of October 2023.
  • In total Lighthouse trust had 87,902 recipients of care alive as of October 2023

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LH – Rainbow

LH – KCH

LH – MPC

LH – UFC

LH – Tisungane

www.mwlighthouse.org

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Background

  • 1.8 million adolescents were living with HIV (ALHIV) in 2022, approximately 1.5 are living in sub-Saharan Africa and 48% have psychosocial issues (UNAIDS 2022)
  • Malawi faces a high prevalence of HIV, particularly among adolescents, necessitating focused attention on comprehensive healthcare interventions
  • ALHIV often encounter unique psychosocial challenges, including stigma, mental health issues, and the complex interplay of adolescence and chronic illness
  • Lighthouse Trust Tisungane clinic operates a teen club for ALHIV and incorporated a a proactive response to address the specific needs of ALHIV needing mental health care
  • Understanding the impact of psychosocial interventions on clinical outcomes is crucial for assessing the overall effectiveness of the healthcare strategies used in the adolescent program
  • We assess the effect of the psychosocial intervention at Tisungane among ALHIV

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Lighthouse Adolescent program 10-19 years�

  • To address challenges related to sustained treatment adherence among adolescents living with HIV
  • Occurs once every month on Saturday.

Eligibility Criteria

  • Fully disclosed of HIV status >> aged 10 -19
  • Consent obtained from both guardian and child
  • Teen club package includes; health education, reproductive health services, HIV services (Viral load, drug refills) gender based screening and psychosocial counseling

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www.mwlighthouse.org

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Psychosocial Intervention Techniques

Psychosocial session

Group/individual session

Psychosocial education

Depression screening & Management using PHQ-9

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Methodology

  • Tisungane clinic had 6908 recipients of care alive in care as of December 2021 of which 780 were adolescents below the age of 19

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  • 232 of the 560 adolescents (aged 10-19) were assessed and managed on various psychosocial issues

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  • Conducted a retrospective record review for adolescents referred to psycho-social counselling between January-December 2022

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  • Data sources: Psycho-social register, Electronic medical records system (EMRS)

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Results | Reasons for referral

  • 232 clients referred for psychosocial counseling
    • 53% were female

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  • Most common reason for referral were poor adherence followed by depression and GBV

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Results | Issues presented by the adolescents

  • Most clients experienced depression, anxiety, stress and social issues

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  • 5% had substance abuse

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Results | Client Outcomes post counseling

Outcome

Number of clients

%

Total referred

232

 

Alive in care

228

98.2%

Transferred out

3

1.2%

Died

1

0.4%

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Challenges and best practices

Challenges

Best Practice

  • Insufficient psychosocial counselors in comparison to the patient volume
  • Teamwork among all health workers regardless of the cadre
  • Adolescents changing guardians before a follow up session
  • Availability of the psychosocial counsellor on majority of clinic days

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  • Good working relationship with other stakeholders working in the district

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  • Availability of resources required for home visits

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Conclusions and recommendations

  • Psychosocial interventions offer a platform for optimal clinical ART outcomes
  • Care systems must prioritize integrating mental health support into HIV care across the lifespan, from childhood to adulthood
  • Implementing routine screening for psychosocial issues among ALHIV to enhance early identification and management will ultimately improve ART adherence
  • Provider mental health training needs to be strengthened
  • Govt should consider recruiting more psychosocial counselors to meet the demand

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www.mwlighthouse.org

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Zikomo