Antoine Nsong, MD

Nominated From: University of Washington

Research Site: University of Yaounde

Research Area: Epidemiology methods, HIV/AIDS Health services research, Implementation sciences

Primary Mentor: Carey Farquhar

Research Project

Evaluation of a Peer Champions’ Differentiated Care Model on Adolescents’ Adherence to HIV Care: an Implementation Sciences Study (Youth-Shine Study).

In Cameroon, an estimated 13% of adolescents living with HIV are having access to ART in 2014. With recent rollout of test-and-treat, the most pertinent gap presently, in the HIV care cascade lies in the area of adherence and retention in care. The most appropriate intervention model to get them adherent to ART with viral load suppression is still under investigation, especially in sub-Saharan Africa. Adolescents have limited access to health facilities, are prone to sexual coercion, and peer pressure. Adolescents have been described as the ‘fulcrum’ or ‘center of the epidemic’, with 42% of new HIV infections occurring in this age group in 2010 worldwide.
PEPFAR recently conducted a differentiated care delivery (DCD) program to reach adolescents in the Limbe regional and Buea regional hospital and Baptist Hospital Mutengene, Cameroon. The aim is to get adolescents into care and keep them on treatment. We aim to find out if an intervention involving provider counselling and support from an adolescent peer will improve ART adherence and engagement in care among Cameroonian adolescents.
This is a mixed methods sequential exploratory (development) study to evaluate the use of peer navigators on Adolescents’ adherence to HIV care.
In this study, we do 2-step mixed methods- wherein we first do a qualitative study to assess barriers and facilitators to adherence to HIV care amongst adolescents enrolled in the differentiated care model. Weighted themes are then used to draft a wider case-control study to evaluate treatment outcomes in those exposed to the new care model (cases) versus those unexposed to the model (controls).
1) To characterise the factors leading to poor treatment outcomes( evidenced by unsuppressed viral loads) in adolescents living with HIV enrolled in in the peer champions differentiated care model (teen club challenge) in 3 HIV clinics in South West Cameroon .
Hypothesis: Adolescents living with HIV enrolled into peer champion differentiated care model clinics have no significant improvement in viral load outcomes (>10 difference) with those in the standard of care. Participants who reported low levels of formal education, lack of social support, a healthy disposition, travelling a lot, negligence, felt stigma, difficulty remembering drug administration schedules, drug toxicities as significant barriers to adherence
Methodology: Sequential exploratory mixed methods with an initial qualitative directed content analytical study followed by a case-control study
2) To determine barriers to engagement in HIV care for adolescents enrolled in the peer champion differentiated care model.
Methods: a qualitative grounded theory framework.


Research Significance

Adolescents experience greater vulnerability to HIV and their performance along the HIV treatment cascade is worse than other age groups. Thirty per cent of new HIV infections occurred among adolescents and youth (15–24 years) in 2014, and HIV is the second leading cause of death among adolescents globally (UNICEF, 2016; UNAIDS 2015).

Advice for Potential Candidates

Get online and learn about the fellowship. Try and meet up with alumni and talk with them. Write a convincing research proposal and identify faculty affiliated with the fellowship to work with. Get recommendations from these faculties and use these to solicit support from the US-based partner universities. Use both these sets of recommendations and your proposal (which must have been thoroughly reviewed by these faculties) to apply for the fellowship. Hopefully you will get it. Don’t feel unqualified to apply for the fellowship, it is open to the most inexperienced, but most curious of budding scientists.