Community-Based Accompaniment for Adolescents Transitioning to Adult HIV Care in Urban Peru: a Pilot Study

Introduction Adolescents living with HIV (ALWH) face an elevated risk of poor health outcomes when transitioning into adult-oriented care; however, evidence-based interventions to support ALWH during this high-risk period are lacking, especially in Latin America. We conducted a pilot study of a community-based intervention designed to improve outcomes among ALWH transitioning to adult HIV care in Lima, Peru. Methods From October 2019 to January 2020, we enrolled adolescents transitioning to adult HIV care, either due to a recent diagnosis or having aged out of their pediatric clinic. ALWH previously lost from care during the transition process were also invited to participate. The nine-month intervention consisted of (1) logistical, adherence and social support delivered by entry-level health workers who accompanied adolescents during their transition to adult HIV care and (2) group sessions to improve health-related knowledge, skills and social support. We assessed intervention feasibility and effectiveness in improving medication adherence, psycho-social outcomes, and transition readiness after 6, 9, and 12 months. Results We enrolled 30 ALWH, ages 15-21 years; 11 were recently diagnosed and 19 had been living with HIV since infancy or early childhood. Participants included ten men who have sex with men, four young pregnant women and six adolescents who were previously lost during the transition to adult HIV care. Intervention participation was high with 90% of ALWH attending at least one in-person social support session and all attending at least one live online session. No ALWH withdrew from the intervention, study, or antiretroviral therapy. In transition readiness, we observed within-person improvements related to personal health (+1.9 points, p<0.001), healthcare usage (+2.4 points, p<0.001), knowledge (+3.3 points, p=0.001), and behavior (+3 points, p=0.003) at the end of the intervention, relative to baseline. We also observed strong evidence of improvements in medication adherence, social support, self-efficacy, and perceived stress, which were generally sustained three months after intervention cessation. Conclusion We identified a community-based intervention that is feasible and potentially effective for bridging the transition to adult HIV care among a diverse group of ALWH in Peru. A larger-scale effectiveness evaluation, including biological endpoints, is warranted. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT05022706 ### Funding Statement This research was entirely supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number R21AI143365. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was granted by the Institutional Research Ethics Committees of the Instituto Nacional de Salud del Nino, Hospital Nacional Arzobispo Loayza, and Hospital Nacional Hipolito Unanue in Peru. In addition, ethical approval was granted by the Institutional Review Board (IRB) of the Harvard Faculty of Medicine at Harvard Medical School in the USA. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The authors confirm that the data supporting the findings of this study are available within the article and its supplementary material. * ALWH : adolescents living with HIV, ART : antiretroviral therapy, CBA : community-based accompaniment, CHWs : community health workers, DOT : directly observed treatment, HIV : human immunodeficiency virus, MSM : men who have sex with men, PLWH : people living with HIV, SES : Socios En Salud, SMS : short message service, TGW : transgender women, YAB : youth advisory board