Accelerating Uptake of Optimal Antiretrovirals for Children and Adolescents Living With HIV in Nigeria, Tanzania, Uganda and Zambia Through Data-driven Quality Improvement Interventions

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BACKGROUND: Limited access to disaggregated pediatric antiretroviral therapy (ART) data by weight, as recommended by the World Health Organization, made treatment optimization challenging. This article describes the treatment optimization interventions for children and adolescents living with HIV (CALHIV) implemented by the Faith-based Action for Scaling-Up Testing and Treatment for Epidemic Response (FASTER) initiative, assesses changes in optimal ART and viral load suppression (VLS) over time and offers lessons learned. METHODS: During January 2020-December 2021, FASTER supported treatment optimization in 245 high-burden facilities across Nigeria, Tanzania, Uganda and Zambia. We collected and analyzed quarterly ART uptake for CALHIV 0-19 years by regimen and weight band (3-19.9, 20-29.9 and ≥30 kg) as the primary outcome in FASTER-supported sites to inform course correction. We also analyzed VLS and viral load coverage among CALHIV between FASTER-supported and non-FASTER-supported sites. RESULTS: Quarterly ART data analysis informed targeted ART training and mentorship of 1230 health workers and 4927 community members. A total of 225 facilities reported regimen data, covering 30,208 CALHIV. The proportion of CALHIV on optimized treatment regimens increased from 49.0%-66.4% at baseline to 82.6%-91.9% at endline across countries. VLS increased from 79% to 91% in FASTER sites and 77% to 90% in non-FASTER sites. CONCLUSIONS: We saw dramatic improvements in optimal ART uptake overall. FASTER-supported interventions, such as data use and training, may have contributed to these increases. Optimal ART uptake likely contributed to improvements in VLS observed in both FASTER and non-FASTER sites given efforts to drive nationwide scale-up of optimal ART.

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