Stakeholders from the East African Point of Care Viral Load(EAPOC-VL) study converged on 1st August 2024 for a meeting at the Uganda Virus Research Institute to discuss and share lessons from the research project. These included clinicians, study nurses, high viral load focal persons, counselors, and site coordinators at all EAPoC-VL study sites in Uganda, namely Mildmay, TASO, Uganda Cares in Masaka, and the Family Hope Clinic in Jinja.
The purpose of the EAPOC-VL project is to examine the feasibility, acceptability, and effectiveness of using point-of-care viral load(PoC VL) monitoring to improve virological suppression among young people (age 15–24) living with HIV in Kenya, Rwanda, and Tanzania, and Uganda. The intervention that has been implemented and studied is the use of point of care (PoC VL) at peripheral health centers which has been compared with the standard of care (centralized VL testing done at specialized laboratories). This implementation research project is a cluster randomized study in which selected health facilities in the participating countries were randomized to either use PoC or standard of care to test for HIV viral load.
The overall aim of the EAPOC-VL project is to evaluate the feasibility, acceptability, and effectiveness of using PoC HIV VL monitoring to improve viral load suppression rates among children and adolescents living with HIV in East Africa.
It should be noted that the study had a target enrollment sample size of 952 young people aged 15–24 years at all the study sites within the project. The meeting involved discussions engaging all the participants while drawing lessons from the implementation of the study.
The objectives of the meeting included:
1. Identifying the enablers, opportunities, and strategies that supported the recruitment and follow-up of study participants.
2. Identify key issues to be addressed in support of adopting VL monitoring as a strategy for improving viral load suppression.
3. Identify and document challenges to study implementation and improve retention in care.
4. To document process recommendations for successfully adopting point-care viral load monitoring.
Some of the lessons learned and benefits from the study;
- The stakeholders mentioned that the study turnaround time in the intervention sites helped them make better-informed decisions regarding the young people's health.
- The young people under the care of their grandparents were able to be retained in care. This was so because the grandparents were very much obliged to follow the healthcare instructions from the hospital regarding the children's wellbeing.
- The youth are easily retained in care when health workers do not judge them for the way they dress or look.
- Having adolescent peers attached to the health network of the facility is instrumental in fostering the retention of young people in care.
- the introduction of the Point of care project helped the health workers identify several gaps among their counselors in the way they engaged with the youth.
- The availability of airtime to call the participants was a great innovation as it helped in follow-up and reminded some young people of their next visits and how they were fairing.
- The guarantee of transport facilitation for the young people helped them go the extra mile in meeting some other home and family needs.
- After a deep understanding of the psychosocial aspects of adolescents, the health workers were in a better position to handle the young people with a positive perspective.
The study came with some challenges and these include;
- Most young people still do not understand HIV and the impact it has on them and society.
- It becomes hard to track some of the young people when they go back to school as they switch off their phones at the end of the holidays. This is even worse when the young people do not have reliable next of kin through whom they can be reached.
- The EAPOC-VL study had particular timelines that contradicted the normal routine of their health facilities.
- There was poor engagement with the family systems, especially single-parent-led homesteads as some would be challenged with the need to work extra hours to provide for the children and fail to support the young people in HIV care at home.
- The health facilities lacked adequate human resources and machines.
- In some scenarios, the transport facilitation was not adequate.
These and more items discussed will be shared in a broader report with a wider perspective.