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Monica Chibesakunda�HIV Testing Services & Prevention Medical Mentor�Centre for Infectious Disease Research in Zambia (CIDRZ)

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Utilizing Recency Surveillance Data to Reach Adolescent Girls and Young Women. What are the programming gaps?

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Introduction

  • Adolescent girls and young women (AGYW) face unique challenges related to sexual and reproductive health, including a higher risk of HIV infection.

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  • Despite significant progress in addressing these challenges, gaps in programming persist.

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  • Utilization of recency surveillance data is an innovative approach to inform targeted intervention.

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Background on Recency Testing in Zambia

  • HIV recency surveillance program implemented in Zambia since 2021 to:
    • monitor demographic characteristics of recent HIV infections,
    • identify geographical areas of active transmission,
    • implement baseline viral load testing as the standard of care.

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  • Recent HIV infections - acquired <12 months, and long-term infections acquired >12 months.

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  • Analysis conducted to:
    1. identify potential hotspots of recent HIV infections using routine surveillance data in Lusaka Province, and
    2. informed the targeting of generalized, intensified control and prevention interventions.

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Zambia HIV Recent Infection Algorithm

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The Six Step Approach In The Public Health Response

Identify Possible Transmission Hotspots

STEP 1

Confirm Data and Describe Hotspot

STEP 2

Prepare

STEP 3

Investigate

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STEP 4

Recommendations to Strengthen Public Health Programs

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STEP 5

Close Response

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STEP 6

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Potential transmission Hotspots identified in Lusaka Province (Oct21- -Apr22)

    • Two significant hotspots of recent HIV infection identified using SatScan

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    • 15 facilities total with 8 in cluster 1 and 7 in cluster 2B

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Triggered by:

  1. Exceeding spatiotemporal threshold.

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  • Exceeding Health facility numerical threshold.

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Note that the Public Health Response is generalized.

Public Health Response in Lusaka Province

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Total

%

Unsuppressed

RITA Recent

%

​

14,535

​

9,216

660

7%

Age Group

​

​

​

​

​

15-19

518

4%

382

60

16%

20-24

2,021

14%

1,408

171

12%

25-29

3,149

22%

2,062

159

8%

30-34

2,866

20%

1,748

113

6%

35-39

2,432

17%

1,449

81

6%

40-44

1,666

11%

982

38

4%

45-49

1,004

7%

617

21

3%

50-54

478

3%

312

8

3%

55-59

209

1%

140

5

4%

60-64

107

1%

66

3

5%

65+

62

0.4%

38

1

3%

missing

23

0.2%

12

0

0%

Gender

​

​

​

​

​

Male

5,356

37%

3,600

190

5%

Female

9,092

63%

5,574

463

8%

missing

87

1%

42

8

17%

15-19 years RITA recent : 92 (9% total)

    • Males: 4 (4%)
    • Females: 92 (96%)

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20-24 years RITA recent: 269 (27% total)

    • Males: 38 (14%)
    • Females: 231 (86%)

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​

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Recent Infection Surveillance Site Assessment Form

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GAPS

  1. Adolescent peers
    • Inadequate numbers
    • Not trained in Adolescent HIV Package
    • No adolescent peer in the Maternal and Child Health (MCH) department to provide Safe and Ethical index testing (SEIT).
  2. Poor HIV self test (HIVST) kit distribution.
  3. Not all identified high-risk negative AGYW were linked to prevention services.
  4. No Key Population (KP) hubs in the catchment area to provide services.

SOLUTIONS

  1. Adolescent peers
    • Identified and allocated to Youth Friendly Spaces (YFS).
    • Capacity building done in collaboration with the Provincial Health office.
    • Trained adolescent peers identified and allocated to MCH.
  2. HIVST kits mobilized, and capacity building done.
  3. High risk negative AGYW referrals escorted to the YFS for targeted case-finding (SNS) and prevention service provision.
  4. Stakeholder engagement meeting held and KP hub opened within catchment area.

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Health Facility Assessment in the two PHR facilities in Lusaka

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Targeted Testing Interventions in the two PHR facilities

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Facility​

Community​

Recruiters​

37​

5​

Offered social network testing​

37​

5​

Accepted​

37​

5​

Identified under social network​

148​

17​

Tested​

148​

17​

Positive​

6​

4​

Linked ​

6​

4​

Known positives​

7​

0​

SNS Findings 1-31 August 2023

Index Testing Apr 2022-Sept 2023

PHR launched

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PrEP_New Trend in the two PHR facilities

PHR

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Ongoing Program Gaps in the two PHR facilities

  • Poor data quality at health facility (HF) level.

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  • Gaps in the surveillance data
    • does not capture factors that recognize and address the diverse needs and challenges faced by different groups of AGYW.

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  • Inadequate number of trained human resource in providing appropriate care to AGYW.

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  • Lack of age-appropriate messaging in HFs and YFS.

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  • YF services are only provided during a specific time of the day.

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Key Take Home Points

  • Recency surveillance data is useful for identifying hotspots for recent infections and age groups affected.

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  • Targeted testing and prevention interventions must be implemented by a multidisciplinary team as part of the public health response.

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  • AGYW must be referred to appropriate services to address their specific needs and challenges.

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  • Recency hotspot mapping facilitates precision public health in limited resource settings.

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Acknowledgements

Thank You!