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introduced at a tertiary HIV clinic in Malawi to provide Africa reported some of the transition challenges as a lack of
ALHIV on ART with dedicated clinic time, peer mentorship, appropriately trained staff; a lack of specialist adolescent-
SRH education, ART refill, and support for positive living friendly services, policies, guidelines and training; and a lack
and treatment adherence. An evaluation of the programme in of health education especially to address SRH and planning.
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2015 found that ALHIV with no Teen Club exposure were less A study in South Africa reported adolescent and health care
likely to be retained than those with Teen Club exposure provider resistance to transition because of the strong
(adjusted odds ratio [aOR] 0.27; 95% CI 0.16, 0.45). Adolescents attachments and relationships built over time, as well as a
living with HIV aged 15–19 years were more likely to have lack of communication between paediatric and adult care
attrition from care than those aged 10–14 years (aOR 2.14; providers. In Namibia, adolescent transition involves
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95% CI 1.12, 4.11). Concerns have been raised about waning achievement of three goals: (1) Full disclosure by the age of
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adherence over time, including loss of patients from HIV 10–12 years, with an understanding of HIV prevention
programmes when scaling up. Recommendations for measures and linkage to an adolescent support group;
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monitoring long-term retention rates, and the development (2) understanding of medication by those aged 13–16 years,
of evidence-based interventions to address problems, including adherence/appointment keeping and being part of
especially among adolescents, have been put forward. 8 a support group; and (3) understanding of the importance of
medication adherence in the last two to three clinic visits by
Namibia has adopted the fast track goals of the Joint United those aged 17–19 years, with encouragement for the
Nations Programme on HIV and AIDS to control the HIV adolescent to attend clinic visits independently, and if the
epidemic by 2030. The fast track goals are aimed at ensuring adolescent is 19 years and has achieved goal 3, transitioning
that 90% of people living with HIV (PLHIV) are identified; them to adult care with their consent. Paediatric care staff
90% of those identified are effectively linked and retained on follow up the transitioned adolescent for at least one
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ART and that 90% of these achieve viral suppression. In suppressed viral load. 17
Namibia, 15- to 25-year olds reportedly have only 64.5%
(females) and 60.7% (males) viral suppression; which is A Teen Club intervention was established in 2010 at the
below the national average suppression levels for older Intermediate Hospital Katutura Paediatric ART Clinic in
adults on ART at 92.5% and 86.3% for females and males Windhoek to address the unique needs of adolescents on
respectively. 10 HIV treatment. The Teen Club aims to improve retention
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in HIV care through, among other activities, psychosocial
The HIV programmes of several countries have demonstrated support, HIV counselling and health education. The Teen
the effectiveness of group-based interventions in improving Club is a psychosocial peer support group and does not
retention in care among adults. A systematic review of offer special arrangements for clinic or treatment (pill
literature on improving retention among adolescents and pickup) visits. All adolescents receive their medication
adults in low- and middle-income countries reported that through an appointment system, with a standard treatment
only one study evaluated HIV programmes for youth and clinical monitoring schedule. Although the Teen Club
(15–24 years) while several studies reported associations is a voluntary peer support group, the clinic staff encourage
between task shifting of services, down-referral of stable all adolescents who have completed their HIV disclosure
patients, decentralisation, differentiated care and retention process to enrol in the Teen Club (see comparison of services
in care rates among adults. A study of community-based offered in Standard care vs Teen Club in Table 1). To date,
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service delivery that was effective for adults was found to be the effectiveness of the Teen Clubs on retention of
not effective among the youth. An evaluation study on the adolescents in care has not been formally evaluated in
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effect of a novel adolescent and youth Red Carpet Programme Namibia. This article reports on the effects of the Teen Club
on linkage to care and outcomes conducted in health care intervention against standard care on retention in care
facilities and schools in Homa Bay County, Kenya, showed among adolescents at the clinic.
that when compared to the pre-implementation cohort,
retention on ART for the post-implementation cohort Methods
increased from 66% to 90% at 3 months, and from 54.4% to
98.6% at 6 months. The WHO proposes support groups as Study setting, design and population
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an intervention for improving retention in care for persons A retrospective cohort study was conducted using medical
receiving ART, and that the effectiveness can be maximised if records of HIV-positive adolescents aged between 10 and
support groups are formed around homogenous population 19 years receiving ART at a hospital-based paediatric clinic in
groups such as couples, men having sex with men or Windhoek, Namibia. The study population was stratified
adolescents. 13 into two groups: adolescents attending the Teen Club and
adolescents receiving standard care. Routine clinical records
Adolescent transition to adult care outcomes have been of the study population from 01 July 2015 to 30 June 2017
reported mostly in the Global North, but these types of were reviewed. All adolescents aged between 10 and 19 years
evaluations are less available in sub-Saharan Africa because that attended the clinic between 1 July 2015 and 30 June 2017
of limited resources that increase the complexity of transition as their initial enrolment site were eligible for inclusion in
and its assessment. Multicountry assessments conducted in the study. According to the 2014 Namibian National ART
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http://www.sajhivmed.org.za 369 Open Access