Optimizing Antiretroviral Treatment and Viral Suppression for Adolescents and Young People Living with HIV by Implementing Operation Triple Zero in Four States in Nigeria: Lessons Learned

The initiative aims to optimize antiretroviral treatment and viral suppression for adolescents and young people living with HIV (AYPLHIV) through a multifaceted strategy. The OTZ approach includes adolescent-focused case management, peer-to-peer support and behavioral interventions to identify and address age-specific barriers to adherence, and add-ons such as free Wi-Fi and games to improve adherence to clinic appointments. AYPLHIV are also involved in care through the election of "youth champions" who are trained to support health workers in providing adherence support, offer clinic navigation for new patients, and provide peer-to-peer mentoring. Talent nurturing and caregiver education are integral components of the OTZ approach. AYPLHIV are integrated into skills acquisition programs such as computer literacy and culinary skills, while caregivers are trained on positive parenting and adolescent-responsive services. The initiative also involves collaboration with services for orphan and vulnerable children (OVC) for home tracking of treatment interruption, psychosocial support, transport to the health facility, and nutritional support. The OTZ approach has shown significant improvements in viral load testing coverage and viral suppression rates among AYPLHIV. By September 2020, 99% of AYPLHIV were on optimal regimens, and 78% had a viral load test done. The viral suppression rate increased from 67% to 82% among 10-14 year olds, from 52% to 83% among 15-19 year olds, and from 68% to 85% among 20-24 year olds. The findings of the OTZ initiative highlight the importance of AYPLHIV involvement and commitment to self-care in improving adherence. Caregivers' involvement in healthcare also improved outcomes among AYPLHIV. The initiative demonstrates the effectiveness of integrated, asset-based strategies in improving HIV treatment outcomes among AYPLHIV. The OTZ approach has been implemented in 38 local government areas, with 103 health facilities supported, and 4,617 of 5,769 eligible AYPLHIV enrolled. The initiative has also trained 66 AYPLHIV as youth champions across 33 high-volume facilities to support clinic activities. The OTZ approach has been made possible with support from the U.S. President's Emergency Plan for AIDS Relief, through the United States Agency for International Development funded RISE program.