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.

Keywords: HIV & AIDS; epidemiology; public health.

Figure 1

Data flow diagram describing how the analysis dataset of 532 individuals was derived from the full dataset of 829 adolescents enrolled in HIV care during any part of the study period (January 2015 to May 2021). The numbers between this figure and online supplemental table S1 do not correspond because this figure includes all patients who had been in the cohort over the study period.

Figure 2

Kaplan-Meier survival curve for adolescents enrolled in teen clubs (top teal line with shaded 95% CI) and standard care (bottom red line with shaded 95% CI) over 50-month follow-up. Nine patients were censored at month 0 due to a very short-time interval (<30 days) between dates of antiretroviral treatment initiation and outcome.