Impact of implementing “adolescent- focused” services in Haiti Rachel Bertrand MD, Lindsey Reif MPH, Serena Koenig MD, JW Pape MD

Background Half of all new HIV infections High risk for failing to initiate treatment and adhere to ART. More than 50% of adolescents on ART had a drug resistant virus and were not considered adherent to treatment. ( GHESKIO/Port-au-Prince ) Only 20% of HIV-infected youth are disclosed

Background Barriers to HIV testing : low perception of personal risk, fear of stigma, “youth- hostile” clinic environments, and lack of provider-initiated HIV testing when youth seek medical attention. Majority of HIV-infected adolescents : not disclosed, unprotected sexual intercourse, late for appointment, increase of morbidity and mortality

Methods Need to improve prevention and treatment in this vulnerable population Developed and implemented ‘adolescent- focused’ services Country’s first Adolescent HIV Clinic Creating the first adolescent community advisory board (CAB)

Results Increased the amount of HIV-infected adolescents diagnosed. Over the last 20 years, 7-fold increase in the number of HIV-infected adolescents ages 15 – 24 years diagnosed Rising from ~ 100 HIV-infected adolescents diagnosed in 1993 to ~700 in 2013 (Figure 1).

Results Over 80% of those diagnosed are young women. After 5 years of operating the Adolescent HIV Clinic: 1. ART adherence rates :45% to 70%, 2.mortality : 13% to 7%, 3. unwanted pregnancies: 25% to 8%.

Impact of implementing “adolescent-focused” services in Haiti

Conclusions The next step is to develop a standard protocol for adolescent HIV services that can be scaled-up as the standard of care in HIV clinics throughout Haiti.