Implementation evaluation of the Paediatric and Adolescent Scale- up Plan for 90-90-90 HIV outcomes in the inner City of Johannesburg, South Africa

Abstract

Background Global efforts have averted over 1.4 million new HIV infections among children, but in 2017, only half of the 1.8 million HIV-positive children received life-saving antiretroviral treatment (ART). To address this disparity, the ambitious 95-95-95 targets aim for 95% of people living with HIV (PLHIV) to be diagnosed, treated, and virally suppressed by 2030. Despite progress, gaps persist in achieving South Africa's paediatric and adolescent HIV goals. To bridge these gaps, the Paediatric and Adolescent Scale-up Project (PASP) was implemented in Johannesburg from 2015 to 2018. PASP aimed to enhance diagnosis, treatment, and viral suppression among children (10-14 years) and adolescents (15-19 years) living with HIV. Knowledge on the implementation fidelity of HIV care and treatment strategies for Children Living with HIV (CLHIV) and Adolescents Living with HIV (ALHIV) in public health facilities is limited. Methods PASP aimed to enhance HIV care for children and adolescents in Johannesburg, South Africa, through quality improvement and technical assistance from 2015 to 2018. This study analysed data, project records, and stakeholder insights to assess strategy effects, implementation fidelity, and barriers to achieving 90-90-90 targets. Results Facility-based strategies showed better outcomes across the HIV cascade, compared to community-based strategies. Index case finding and hospital-based testing, exhibited higher yields (3.3% and 5.3% respectively) of HIV-positivity, while key entry point testing (5.6%) showed higher yield among adolescents. Data-driven strategies improved ART initiation, with 65% of previously diagnosed children traced and initiated on ART. Psychosocial support (PSS) and Enhanced Clinical Care (ECC) improved retention and viral load suppression. By the end of the project, 74% of adolescents and 82% of children were virally suppressed. HIV management guidelines, training and mentoring, and tools facilitated the implementation of these strategies. v Conclusions The study highlights promising strategies for improving HIV outcomes among children and adolescents in public health facilities. However, few strategies showed a significant effect on the outcomes and limited documentation of process data hindered exploration of implementation fidelity. Ongoing barriers require evidence-based solutions to enhance implementation and patient outcomes. By addressing these challenges, healthcare providers can optimize HIV care and treatment for vulnerable populations, moving closer to achieving the 95-95-95 targets.