Adolescents adhere to care when appropriate services are provided: Nkwen Baptist Health Center says it is possible

By Fri Delphine

“14 years ago, when I started treatment, I was obliged to listen to what I considered absurd lectures amid adults at treatment centres and queued in with them for my ARVs. Before long, I defaulted. I didn’t see how it was helping me.” For Donald, who is now 28-years-old, HIV services were incredibly unfriendly when he was a 14-year-old adolescent.

With the first case of HIV diagnosed in Cameroon in 1985, the numbers increased at an astronomical rate. By 1997, 7% of Cameroon’s population were living with HIV, among which were over 420,000 adolescents (UNAIDS). The repercussion of the pandemic greatly affected the already limping workforce in hospital settings, making it challenging to offer quality care to everyone in need. The groaning of clients could be heard in all treatment centres across the country, and Nkwen Baptist Health Center was one of them.

We were overwhelmed with work, and to make matters worse, we did not have the skills to educate youngsters on the importance of medication nor were we equipped to listen to their challenges and address them. This explained why we had almost 30% defaulter rate on average monthly.” Florentine, a service provider at Nkwen Baptist Health Center, explains.

Rough Days for Children and Adolescences in Nkwen Baptist Care and Treatment Centres

In 1999, the Prevention of Mother-to-Child Transmission (PMTCT) was rolled out within the CBC Health Services with the Nkwen Baptist Health Center as one of the implementing sites. While this program focused on women and their babies, children and adolescents living with HIV were still waiting for an opportunity for their voices to be heard. As years passed, more children and adolescents defaulted; some were lost to follow-up, while those who managed to adhere kept clamouring for their voices to be heard in matters that concerned their treatment and health.

“I started treatment when I was nine-years-old, I was very adherent most of the time, but when I crossed the age of 17, I wanted to date, I wanted to have sex, yet I had no teachings that validated my emotions, be it from home or my service providers. Hence, I defaulted, got sexually active and a year later, I was rushed to the emergency room. I almost lost my life.” Twenty-three-year-old Quinta says, sharing a story that is familiar to many.

I just got fed-up with the system in place; I felt they were more concerned with me drinking tablets without checking how I actually felt. I sincerely believed the service providers weren’t there for me but to fill their registers. I took the pills, but I hardly felt well because my soul was miserable,” Donald explains.

Donald and Quinta were among the 97 children and adolescents on ARV treatment at the Nkwen Baptist Health Center in 2010. They, and many of their peers, could speak for hours about their painful experiences navigating the health facility to get the help they needed. “How could people think and decide for us, without us? This question troubled me through my adolescence.” Quinta says, as she recalls her youth. “Things have drastically improved”, she adds.

Adolescents working with service providers to produce microplans to address their needs. Photo credit: Fri Delphine
Service providers are trained to meticulously retrospect through the growth charts of children and adolescents to ensure they are health and growing well.
"The health facility is the only place where I am comfortable to take off my mask and feel free amongst my peers." - Harriette, 14 years old. Photo credit: Fri Delphine

My Health My Voice; Children Momentum Project Making the Difference

In 2016, with funding from Paediatric-Adolescent – Treatment Africa (PATA), Nkwen Baptist Health Centre (NBHC) engaged two adolescents living with HIV to serve as Peer Supporters for the first time. These Peer Supporters were responsible for providing adherence support to their peers, listening to their fears and challenges and sharing their own experiences to give them hope, preparing those newly diagnosed for ART and, above all, providing feedback to service providers on how they want services provider to young people. Learning from the experience at NBHC, the CBC Health Services, with funding from ViiV Healthcare and technical support from PATA, has engaged 19 peer supporters in 16 health facilities in the Northwest Region of Cameroon. The design and implementation of this scale-up project titled “Children Momentum Project” are adolescent-led and ensure children and adolescents are at the centre of their care. These Peer Supporters have skills that they have gained through their own experiences and are now in a better position to help their peers live a better life with HIV.

“This generation is privileged to have peers in the health facility offering tailored care to them. I must confess that the service providers have also become exceptional in dealing with my peers,” Donald explains, his face brightening as he speaks.

Service providers were capacitated to adapt to this paradigm shift of addressing these children’s physical and emotional needs from a non-judgmental approach. Service providers learned how to work with children and adolescents through power points, role plays, and continuous follow-up.

We used to shout at adolescents for not taking medication, but growing closer to them has made us understand their troubles better. Coming from a non-judgemental approach has made them open up, and we can help them by finding solutions together,” Florentine, a service provider, working with adolescents at NBHC, says.

This peer support model not only focuses on a child’s well-being in the hospital setting but works hand-in-hand with families, caregivers and communities to ensure these adolescents are accepted back home, and thus feel loved and stay healthy physically and emotionally.

“Working with the children made us understand that it takes more than tablets to ensure they are healthy. Hence, we are working with stakeholders outside the hospital to give them the care they deserve.” Fanny Epie, the CMP Program Coordinator, says.

In 2010, NBHC had approximately 92 children and adolescents on treatment, all merged into one group with a defaulting rate of over 35% monthly. However, thanks to the differentiated services delivery approach, children and adolescents were regrouped in different age groups (0-9, 10-14 and 15-19) to facilitate learning and disclosure processes. As of October 2022, NBHC had 266 children on treatment, with a monthly defaulting rate of less than 9%.

At last! My voice is heard.

“I serve as a role model to my peer and the younger generation; we discuss together their day-to-day challenges; they easily identify and listen to me because I am like them, and if I have made it this far, it gives them hope that it is possible,” Donald explains.

NBHC makes adolescents and children living with HIV feel at home whenever they visit the health facility. Despite this success, Nkwen, among 16 other Children Momentum Project Implementation sites, remains isolated amongst several health centres across the country. This also implies that, though these adolescents have learned to accept their status and adhere to treatment, stigma and discrimination are still prevalent , making it difficult for young people to be free. Despite this, Donald remains optimistic. “Fourteen years ago; it was a nightmare! We may not be where we want to be, but we must acknowledge that a lot has changed positively. I am hopeful that the next 14 years will even be better.”

While much has been done to close the gaps and give children living with HIV a means to express themselves, there is still much to do. This is why PATA continues to fund and organise yearly conferences with adolescents and service providers to identify gaps and propose innovative strategies to close them. On November 21-23, 20202, under the “Uniting to Do it Right, Do it Together. Do it Now”, stakeholders, nurses, doctors, adolescents and young people living with HIV, programme managers, community partners and Ministries of Health around Africa involved in the fight to end HIV in children and adolescents, will be meeting to agree on what is needed for the continent to end AIDS and advance the 2030 agenda.