Lucie D Cluver1, Rebecca J Hodes, Elona Toska, Khameer K Kidia, F Mark Orkin, Lorraine Sherr, Franziska Meinck. 1. aCentre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, Oxford, UK bDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa cAIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa dArnhold Global Health Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA eDST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa fHealth Psychology Unit, Department of Infection & Population Health, University College London, London, UK.
Abstract
OBJECTIVES: WHO guidelines recommend disclosure to HIV-positive children by school age in order to improve antiretroviral therapy (ART) adherence. However, quantitative evidence remains limited for adolescents. This study examines associations between adolescent knowledge of HIV-positive status and ART-adherence in South Africa. DESIGN: A cross-sectional study of the largest known community-traced sample of HIV-positive adolescents. Six hundred and eighty-four ART-initiated adolescents aged 10-19 years (52% female, 79% perinatally infected) were interviewed. METHODS: In a low-resource health district, all adolescents who had ever initiated ART in a stratified sample of 39 health facilities were identified and traced to 150 communities [n = 1102, 351 excluded, 27 deceased, 40 (5.5%) refusals]. Quantitative interviews used standardized questionnaires and clinic records. Quantitative analyses used multivariate logistic regressions, and qualitative analyses used grounded theory for 18 months of interviews, focus groups and participant observations with 64 adolescents, caregivers and healthcare workers. RESULTS: About 36% of adolescents reported past-week ART nonadherence, and 70% of adolescents knew their status. Adherence was associated with fewer opportunistic infection symptoms [odds ratio (OR) 0.55; 95% CI 0.40-0.76]. Adolescent knowledge of HIV-positive status was associated with higher adherence, independently of all cofactors (OR 2.18; 95% CI 1.47-3.24). Among perinatally infected adolescents who knew their status (n = 362/540), disclosure prior to age 12 was associated with higher adherence (OR 2.65; 95% CI 1.34-5.22). Qualitative findings suggested that disclosure was undertaken sensitively in clinical and family settings, but that adults lacked awareness about adolescent understandings of HIV status. CONCLUSION: Early and full disclosure is strongly associated with improved adherence amongst ART-initiated adolescents. Disclosure may be an essential tool in improving adolescent adherence and reducing mortality and onwards transmission.
OBJECTIVES: WHO guidelines recommend disclosure to HIV-positive children by school age in order to improve antiretroviral therapy (ART) adherence. However, quantitative evidence remains limited for adolescents. This study examines associations between adolescent knowledge of HIV-positive status and ART-adherence in South Africa. DESIGN: A cross-sectional study of the largest known community-traced sample of HIV-positive adolescents. Six hundred and eighty-four ART-initiated adolescents aged 10-19 years (52% female, 79% perinatally infected) were interviewed. METHODS: In a low-resource health district, all adolescents who had ever initiated ART in a stratified sample of 39 health facilities were identified and traced to 150 communities [n = 1102, 351 excluded, 27 deceased, 40 (5.5%) refusals]. Quantitative interviews used standardized questionnaires and clinic records. Quantitative analyses used multivariate logistic regressions, and qualitative analyses used grounded theory for 18 months of interviews, focus groups and participant observations with 64 adolescents, caregivers and healthcare workers. RESULTS: About 36% of adolescents reported past-week ART nonadherence, and 70% of adolescents knew their status. Adherence was associated with fewer opportunistic infection symptoms [odds ratio (OR) 0.55; 95% CI 0.40-0.76]. Adolescent knowledge of HIV-positive status was associated with higher adherence, independently of all cofactors (OR 2.18; 95% CI 1.47-3.24). Among perinatally infected adolescents who knew their status (n = 362/540), disclosure prior to age 12 was associated with higher adherence (OR 2.65; 95% CI 1.34-5.22). Qualitative findings suggested that disclosure was undertaken sensitively in clinical and family settings, but that adults lacked awareness about adolescent understandings of HIV status. CONCLUSION: Early and full disclosure is strongly associated with improved adherence amongst ART-initiated adolescents. Disclosure may be an essential tool in improving adolescent adherence and reducing mortality and onwards transmission.
Authors: Elona Toska; Lesley Gittings; Rebecca Hodes; Lucie D Cluver; Kaymarlin Govender; K Emma Chademana; Vincent Evans Gutiérrez Journal: Afr J AIDS Res Date: 2016-07 Impact factor: 1.300
Authors: Justin S Nichols; Tassos C Kyriakides; Sampson Antwi; Lorna Renner; Margaret Lartey; Obedia A Seaneke; Raphael Obeng; Ann C Catlin; Geliang Gan; Nancy R Reynolds; Elijah Paintsil Journal: AIDS Care Date: 2018-09-20
Authors: Brian C Zanoni; Moherndran Archary; Tamarra Subramony; Thobekile Sibaya; Christina Psaros; Jessica E Haberer Journal: AIDS Behav Date: 2021-01
Authors: Brian C Zanoni; Moherndran Archary; Thobekile Sibaya; Nicholas Musinguzi; Mary E Kelley; Shauna McManus; Jessica E Haberer Journal: J Int AIDS Soc Date: 2021-07 Impact factor: 5.396