A comparison of antiretroviral therapy outcomes among adolescents in teen clubs and standard care clinics: Blantyre, Malawi
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Date
2021-05-21
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Kamuzu University of Health Sciences
Abstract
Introduction: This is a retrospective cohort study designed to investigate the impact of the teen club model
among adolescents living with HIV on antiretroviral therapy (ART) outcomes in Blantyre. Teen
clubs are among the Differentiated Service Delivery (DSD) models being implemented in Malawi
to improve antiretroviral treatment outcomes. Currently, more studies have been conducted in
Malawi focusing on the impact of teen clubs in adherence to ART and reducing loss to follow up,
but very little has been done to investigate the impact of the model in improving long-term
outcomes of ART such as viral load suppression, reduced virological failure, and prolonged life.
Some African countries such as South Africa and Namibia have recently conducted similar studies.
Objectives:
The primary objective of the study is to compare antiretroviral therapy outcomes among
adolescents living with the human immune-deficiency virus (HIV) in teen clubs compared to those
in standard care clinics. The primary outcome is differences in virological suppression among the
two groups, the exposed (adolescents in teen clubs) and the unexposed (adolescents in the standard
of care). Virological failure and 24 months survival analysis for adolescents in teen clubs and those
receiving standard of care will as be assessed.
Methodology: A comparison of Antiretroviral Therapy outcomes among adolescents in Teen Clubs and Standard Care
Clinics in : Blantyre, Malawi
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The retrospective cohort study will be from the 1st of January, 2018 to the 31st of December,
202019. A sample of 182 adolescents living with HIV on ART from the 6 public health care clinics
in Blantyre will be identified (3 with teen clubs and 3 using the standard of care model). The health
care clinics were identified through stratified random sampling. Stratification was based on the
type of adolescent ART service being provided by the health facility (teen club model or standard
of care). The study sample is all-inclusive of the study population. A case report form will be used
to extract demographic and clinical data from the ART registers, client master cards, and Electronic
Medical Records database. Virological data will be obtained from the master cards and
demographic and ART outcome data will be obtained from the ART registers. STATA 16.0 will
be used to analyze the data and chi-squared and poison regression will be used to analyze the
differences in the two groups and Kaplan Meier curves and Cox proportional hazard method will
be used for survival analysis. The study will be conducted from February to December 2021.
Expected findings and their dissemination.
Based on studies conducted in other countries with a similar setting as Malawi, it is expected that
the teen club model is most likely to improve the long-term ART outcomes as compared to the
standard of care. The outcomes include viral load suppression and virological failure. The results
will be disseminated to the College of Medicine Research and Ethics Committee (CoMREC),
College of Medicine Library, and the University Research and Publication Committee, to College
of Medicine as partial fulfillment of the Master of Epidemiology (MSc in Epidemiology) program,
the District and city health offices, Blantyre city and District AIDS coordination committees and
the Blantyre HIV treatment and care, technical working group.