Analysis of Adolescent HIV Care Cascade Outcomes in PEPFAR-Supported Programs in Central America, October 2020-September 2024.

To better understand recent adolescent (10-19 years) HIV trends in Central America, we analyzed routine data from countries supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR): Guatemala, El Salvador, Honduras, Panama, and Nicaragua, over the period from October 2020 to September 2024. Key PEPFAR indicators included HIV testing, HIV positivity rates, new treatment initiations, advanced HIV disease (AHD) at diagnosis, viral load coverage (VLC), viral load suppression (VLS), and multi-month dispensing (MMD) uptake for children and adolescents living with HIV (CALHIV) from 10-19 years of age. Since October 2020, the number of HIV tests conducted among adolescents has increased; however, the positivity rate has remained stable at approximately 2%. The number of adolescents initiating treatment increased by 21%. At the same time, VLS has shown steady regional improvement (from 73% to 90%), though VLC is a persistent challenge (80%). Treatment interruption rates have been relatively stable, fluctuating between 2% and 3%. Advanced HIV is high in adolescents new to treatment (34%), especially among females (40%), though cluster of differentiation 4 (CD4) testing at diagnosis has only been collected recently and coverage is not complete. The high prevalence of AHD among adolescents underscores the need to reinforce earlier and more targeted interventions for adolescents, especially in countries with greater HIV prevalence such as Panama and Guatemala.