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Cosmas Zyambo,


MBChB, PhD, MPhil

GHES U.S. Fellow 2018-2019

FELLOWSHIP SITE: Centre for Infectious Disease Research in Zambia (CIDRZ)
U.S. INSTITUTION: Yale University

Project Title: Motivational Interviewing for Linkage & Retention to Care of Zambian adolescents living with HIV (MI-LinC)

Scaling up of HIV programs to meet the 90-90-90 targets in Sub-Saharan Africa (SSA) has resulted in nearly 11.7 million people initiating antiretroviral therapy (ART) and 83% of persons in care achieving viral suppression, program effectiveness has been hindered by high loss to follow - up (LTFU). Despite the emphasis of universal testing on one end of the treatment continuum and viral suppression on the other end, linking or re-engagement to care and retention in care are critical integral components to secure optimal health outcomes. Although the HIV incidents transects the socio-demographic strata, surveillance systems have shown that the new incidents of HIV infections are increasing among 15- 24 years  of age , the number of adolescents dying of HIV related diseases tripled between 2000 and 2015 making it the only age group to have experienced a rise, with almost 73% being in SSA. Young women and girls are more likely to be infected, with some parts of SSA having up to eight times more vulnerable than young men. Systematic reviews of studies have shown that of the people who knew their HIV status, on average, 57% completed the eligibility assessment, 66% started ART, and only 65% were estimated to be retained in care after three years of being on therapy.  Studies in the developed and developing countries have suggested that adolescents and young adults are less likely to initiate ART, achieve viral suppression and more likely to be lost to follow - up as compared to the adults. The MI-LinC study proposes an MI-based outreach intervention for adolescents living with HIV lost to follow - up. The study will test the following central hypothesis (H1): Patients who are randomized to a combination of community outreach and motivational interview are more likely to re-engage to care and retained in care than the patients randomized to traditional outreach (SOC)