Across sub-Saharan Africa, children living with HIV (CLHIV) experience higher rates of advanced HIV disease and mortality compared to adults. While access to continuous treatment with antiretroviral therapy reduces this risk of poor outcomes, CLHIV are less likely than adults to be retained in care; up to 20% of CLHIV fall out of care within the first two years of treatment. From 2019-2023, the Georgetown University Center for Global Health Practice and Impact (CGHPI), a PEPFAR implementing partner, rolled out an age-specific comprehensive case management (CCM) package with the goal of improving retention in care among 3,000 CLHIV <10 years old in the East and Center regions in Cameroon. While there has been some anecdotal success in increasing retention rates among CLHIV, the package has not been systemically rolled out and reasons for this heterogenous implementation are unclear. This project aims to assess the implementation and effectiveness of the CCM package in order to identify and prioritize the components that are most effective for improving retention among CLHIV as the program transitions to local leadership.
In order to assess the implementation and impact of the CCM package for CLHIV <10 years old in Cameroon, Robsky and team will conduct a longitudinal mixed-methods study guided by the Implementation Fidelity Framework. In Aim 1, they will quantify the independent association between fidelity of individual CCM components (pillboxes, home visits, parent’s forums, etc.) and retention in care six months post-visit using caregiver exit surveys and data from the existing electronic medical record. In Aim 2, they will conduct focus groups among both healthcare providers and caregivers to identify the barriers and facilitators to implementing and participating in the CCM package and conduct a thematic analysis on the systems-level (workload, attitude, and training) and patient-level (acceptability, cost, and stigma) qualitative domains.
The data collected on the CCM package from this pilot study will support the development of approaches to improving health outcomes among children living with HIV in Cameroon. Specifically, through this pilot award, Robsky and team will 1) rigorously measure fidelity of the CCM package implementation, 2) identify effective components of the CCM implementation, and 3) identify areas for future intervention refinement; these data will be used to inform a future NIH R34 or R01 proposal to refine and evaluate the CCM package, with the goal of conducting a Type II or Type III hybrid implementation-effectiveness trial of an improved CCM intervention. By applying a rigorous implementation science lens, they anticipate that our findings will identify individual and context-specific characteristics associated with successful pediatric HIV case management programs, providing important results to inform pediatric HIV care in Cameroon and similar settings.
Project Summary provided by investigator.