Operation Triple Zero

“Pray for my nephew. He is HIV-positive!” These are the words that Robert John Ouko’s guardian uttered during a church service following the death of Robert John’s mother.
Robert John was then 14 years old, and he was devastated to have his HIV-status disclosed to his entire community. He had known his HIV status since the age of 12 when his mother told him, “Your father died of HIV. You are HIV-positive.”
AIDS is the leading cause of death among young people aged 10 to 24 in Africa and the second leading cause globally.
Whereas 10- to 24-year-olds contribute significantly to new HIV infections in Kenya, access and uptake of HIV testing and counseling and antiretroviral therapy (ART) is significantly lower than among adults.
“The dynamics of adolescence as a stage of life compounded by HIV challenges can lead to very poor treatment outcomes. We provide a package of care and treatment tailored to the specific needs of adolescent.” Daniel Mumelo, senior technical officer at the Elizabeth Glaser Pediatric AIDS Foundation
Daniel Mumelo, a senior technical officer at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) says that against this backdrop, “EGPAF rolled out the facility-based, adolescent-centered Operation Triple Zero (OTZ) model in Homabay County, to reverse negative trends.”
“By agreeing to be enrolled into the OTZ club through voluntary written consent, adolescents commit to zero missed appointments, zero missed drugs and zero viral load,” Mumelo says.
“The dynamics of adolescence as a stage of life compounded by HIV challenges can lead to very poor treatment outcomes. We provide a package of care and treatment tailored to the specific needs of adolescents,” he says.
To avoid trauma and distress, parents and guardians are taken through sessions on how best to disclose HIV status to adolescents living with HIV. Health providers recommend that disclosure be done at age of 10—12 at the latest.
Adolescents are routinely counseled and taken through a series of treatment literacy sessions to improve HIV drug adherence.
OTZ, a club model implemented in 158 out of 164 health facilities across the county, is an initiative that seeks to empower adolescents to take charge of their treatment and commit to the triple zero outcomes.

As of March 2021, the OTZ initiative had a 96 percent coverage. Overall, 88 percent or 5,579 adolescents out of 6,362 are enrolled into OTZ, with a remarkable viral suppression rate of 87 percent—up from 70 percent in 2016 at the onset of the intervention.
In Rangwe Sub-County, one of the facilities with remarkable OTZ outcomes, all 117 HIV positive adolescents are enrolled into OTZ with a viral suppression rate of 97 percent.
“Adolescents receive their services on a designated day. They do not queue to receive services,” says Beryl Achieng Owour, a clinician.
“They also have an OTZ passport that summarizes services offered at any given clinic visit, including their most recent viral load. This way, we can quickly determine whether the patient is responding well to treatment and the best cause of action if they are not,” she says.

Robert John, now 20 years old, is a beneficiary of the OTZ model and is an OTZ Champion. He says that the OTZ club holds quarterly fun days where they mingle with their health providers in dance and games.
During these fun days, heroes (young people who have achieved the triple zero outcomes) share their stories to inspire others.
“Through OTZ, we have networks of HIV-positive adolescents within health facilities, across health facilities, in schools, across schools and in the community. The older ones have social media groups where we keep in touch and encourage each other,” Robert John explains.
“As champions, we also work closely with the Orphans and Vulnerable Children offices to provide financial and nutrition support to those in need as this improves drug adherence,” he says.
The OTZ model was first rolled out by EGPAF alongside other partners. Due to its high yielding potential, Operation Triple Zero has now been absorbed into the Ministry of Health guidelines for the care and treatment of adolescents.

Joyce Chimbi
Kenya
Adolescent Identification, Care & Treatment; HIV Treatment Optimization