Family Connections randomized controlled trial: assessing the feasibility and acceptability of an intervention with adolescents living with HIV and their caregivers in Ndola, Zambia

A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.

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“…The evidence review identified 70 intervention evaluations [29–98]. The literature flow is documented below (Fig.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination

Ferguson

Gruskin

Bolshakova

et al. 2023

Aids

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“…For example, Denison et al pilot-tested the “Family Connections” family-based intervention among AYAs, ages 15 to 19 years, living with HIV in Zambia. Based on positive youth development, Family Connections moved beyond individual level factors to engage the family caregivers (interpersonal level) and health care providers (environmental level) [ 114 ]. To expand on this pilot study, the team is now conducting a National Institute for Mental Health—funded R01 to examine both the impact of Family Connections on youth achieving an undetectable viral load, and if developmental differences among participants (e.g., cognitive functioning, emotional regulation and impulse control) moderate any impact found.…”

Section: Discussionmentioning

confidence: 99%

Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework

Denison,

Willis,

DeLong

et al. 2024

AIDS Behav

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While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevention and care and treatment empirical research. We systematically searched five databases for articles published between 2010 and May 2020, screened abstracts, and reviewed eligible full-text articles for inclusion. Of the 5890 citations identified, 1706 underwent full-text review and 88 met the inclusion criteria: 70 focused on HIV prevention, with only 14 on care and treatment, 2 on both HIV prevention and care and treatment, and 2 on HIV-affected AYA. Most authors described the theory-based multi-level framework as informing their data analysis, with only 12 describing it as informing/guiding an intervention. More than seventy different multi-level theories were described, with 38% utilizing socio-ecological models or the eco-developmental theory. Findings were used to inform the adaptation of an AYA World Health Organization multi-level framework specifically to guide AYA HIV research.

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“…38 Individual-, clinic-, and community-level interventions addressing these and other factors are emerging. [39][40][41] Rapid scale-up of interventions found to be effective will be needed to ensure efforts to end of the epidemic are not compromised. Our study also reinforces others that have documented a substantial decrease in time to ART initiation after launch of treat-all policies circa 2015 and a subsequent increase in viral suppression.…”

Section: Discussionmentioning

confidence: 99%

Modeling the HIV cascade of care using routinely collected clinical data to guide programmatic interventions and policy decisions

Bakoyannis,

Elul,

Wools-Kaloustian

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: The HIV care cascade is a framework to examine effectiveness of HIV programs and progress toward global targets to end the epidemic but has been conceptualized as a unidirectional process that ignores cyclical care patterns. We present a dynamic cascade that accounts for patient “churn” and apply novel analytic techniques to readily available clinical data to robustly estimate program outcomes and efficiently assess progress toward global targets. Methods: Data were assessed for 35,649 people living with HIV and receiving care at 78 clinics in East Africa between 2014 and 2020. Patients were aged ≥15 years and had ≥1 viral load measurements. We used multi-state models to estimate the probability of being in 1 of 5 states of a dynamic HIV cascade: (1) in HIV care but not on antiretroviral therapy (ART), (2) on ART, (3) virally suppressed, (4) in a gap-in-care, and (5) deceased and compared these among subgroups. To assess progress toward global targets, we summed those probabilities across patients and generated population-level proportions of patients on ART and virally suppressed in mid-2020. Results: One year after enrollment, 2.8% of patients had not initiated ART, 86.7% were receiving ART, 57.4% were virally suppressed, 10.2% were disengaged from care, and 0.3% had died. At 5 years, the proportion on ART remained steady but viral suppression increased to 77.2%. Of those aged 15–25, >20% had disengaged from care and <60% were virally suppressed. In mid-2020, 90.1% of the cohort was on ART, 90.7% of whom had suppressed virus. Conclusions: Novel analytic approaches can characterize patient movement through a dynamic HIV cascade and, importantly, by capitalizing on readily available data from clinical cohorts, offer an efficient approach to estimate population-level proportions of patients on ART and virally suppressed. Significant progress toward global targets was observed in our cohort but challenges remain among younger patients.

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Family Connections randomized controlled trial: assessing the feasibility and acceptability of an intervention with adolescents living with HIV and their caregivers in Ndola, Zambia

Cited by 11 publications

References 28 publications

Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination

Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination

Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework

Modeling the HIV cascade of care using routinely collected clinical data to guide programmatic interventions and policy decisions

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