The Ariel Club

Policies and programs to expand access to antiretroviral therapy (ART) in Malawi have made it possible for many infants living with HIV to reach adolescence. However, in most HIV/AIDS treatment facilities, service delivery is more focused on care for adults and children, while the critical needs of adolescents remain largely unmet.

Meeting the needs of adolescents calls for tailored interventions. Addressing the treatment needs of the growing population of adolescents living with HIV (ALHIV) in Malawi will work towards meeting national HIV care and treatment targets, including adherence and viral load suppression. As such, the Elizabeth Glaser Pediatric AIDS Foundation in Malawi is supporting and promoting Ariel Club interventions for ALHIV in EGPAF-supported facilities.

Spotlight on the Ariel Club Strategy: Redefining the ALHIV Narrative

The Ariel Club project is designed to orient HIV treatment and care services to meet the evolving needs of ALHIV in a nurturing environment with peer support. The Ariel Club also seeks to improve the management of HIV-related diseases and drug side effects, medication adherence, viral load suppression, mental health, disclosure, clinical outcomes, and practice of health-promoting behaviors during the transition from adolescence to adulthood.

Since March 2023, EGPAF-Malawi has been implementing the Ariel Club 2.0 package, which is focused on streamlining the process of enrolling ALHIV, ensuring comprehensive delivery of clinical and psychosocial services during the quarterly sessions (previously held monthly), and leveraging multidisciplinary teams consisting of clinicians, nurses, expert clients, and psychosocial counselors to implement sessions alongside ALHIV. In terms of enrollment, Malocho Phoso, Ariel Club 2.0 Implementation Coordinator, notes, “You have to be an adolescent (10-19 years), and you would have had your status disclosed to you before you are enrolled to participate in the sessions.” Phoso highlighted how participant-focused initiatives are a critical element of the Ariel Club 2.0 model: “Selected representatives of ALHIV play a critical role in planning and co-designing the sessions, providing peer feedback on the needs of ALHIV, and participating in post-Ariel Club session debriefs to evaluate implementation.”

Equally important is Ariel Club’s approach of blending “edutainment” (a fusion of education and entertainment) and clinical service provision during meetings. The program employs activities such as clinical assessment and management, group games, drama/theatre activities, sports and art sessions, and discussions on key HIV-related topics, including lessons learnt for the day’s session.

Furthermore, an exciting element of the Ariel Club 2.0 model is using adolescents as wellness managers and warriors to enhance their leadership, peer support process, and navigation through care and treatment. According to Malocho, “Wellness warriors are the ones who are struggling with challenges such as poor adherence, high viral load, missed appointments, and non-acceptance of status. On the other hand, wellness managers are those who have gone through these challenges and have achieved viral load suppression, are adherent and provide support for other ALHIV who are struggling to achieve their goals.”

Why it Matters – Beyond the Numbers

The Ariel Club intervention covers eight Malawi districts with club meetings across 52 EGPAF-supported sites. Since the inception of the Ariel Club 2.0 model in 2023, over 250 Ariel Club meetings have been held across implementing facilities. These meetings, which are usually held during weekends to accommodate both in and out-of-school adolescents, have reached over 5,000 ALHIV with comprehensive care and treatment services and psychosocial support. Participants are further empowered through skill-building sessions to improve their quality of life as they transition to adulthood.

Beyond these numbers, reflections from participants provide insight into Ariel Club’s impact on treatment adherence and quality of life:

“Through Ariel Club meetings, I have realized the danger of missing appointments and why I must regularly take my drugs.”

“I am not falling sick as often as I used to because I am now more adherent after joining the club.”

“I have learnt not to stop taking my drugs when I have disagreements with my parents, as I would fall sick if I refuse to take them.”

“Being supported by both my peers and health workers who encourage me has helped to clear my stress and anxiety.”

“I have made friends and learnt how to fight self-stigma and discrimination, and this has really helped me in living my life.”

These reflections from participants highlight the value of the Ariel Club intervention and the need to expand programming to continue to serve the rapidly growing population of ALHIV in Malawi.

Lessons and the Journey Ahead

While the Ariel Club intervention has shown significant promise in improving care and treatment for ALHIV in Malawi, implementation managers believe that with greater human and material resources to address critical issues, more can be done. Feedback from multidisciplinary team members leading implementation across the facilities indicates the need for greater attention for the club in terms of funding, provision of additional materials to make club sessions more engaging, investments in the transition program that focuses on linkages to continued treatment and adult care, and economic empowerment activities for participants.

In this vein, Ariel Club Project Management Team Member Felix Gent commented on logistics issues: “There is a need for logistical support in terms of helping Ariel Club members with transportation to the facility and also in providing adequate refreshments during sessions.” Ackim Sankhani, Ariel Club Project Management Team Member, also shared feedback, noting challenges relating to data collection and reporting due to the cumbersome nature of the data forms. He also suggested expanding Ariel Club service packages to be more responsive to the needs of diverse ALHIV groups, especially those who are pregnant and breastfeeding, and providing adequate transition plans for participants to maintain desired care and treatment outcomes after leaving the club.

To address some of these challenges, the team has revised data collection and reporting forms, moved from monthly to quarterly meeting schedules to improve logistics coordination and participation, and strengthened participant transition plans. Moving forward, targeted efforts are being made to strengthen caregiver engagement, especially in providing disclosure to adolescents, and to standardize Ariel Club implementation across all facilities, including adopting innovative practices to improve overall care and treatment outcomes. Lessons from the Ariel Club intervention provide critical opportunities for key actors to adopt and commit to improving the quality of life of ALHIV across Malawi.