Clinic and care: associations with adolescent antiretroviral therapy adherence in a prospective cohort in South Africa

Cluver, Lucie; Shenderovich, Yulia; Toska, Elona; Rudgard, William E.; Zhou, Siyanai; Orkin, Mark; Haghighat, Roxanna; Chetty, Angelique Nicole; Kuo, Caroline; Armstrong, Alice; Sherr, Lorraine

doi:10.1097/qad.0000000000002882

Cited by 19 publications

(29 citation statements)

References 56 publications

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“…Previous literature has demonstrated that high rates of HIV and SRH service utilization among adolescents could be achieved by providing these HIV and SRH services within schools (11,32–34). In light of this evidence, the South African government has taken steps towards providing HIV and contraceptive services in schools under the Integrated School Health Programme (12).…”

Section: Discussionmentioning

confidence: 99%

“…There is a growing body of research examining which aspects of SRH service delivery influence a young person's decision to access services. It appears that confidentiality of services, stigma from health workers, operating hours, and costs of accessing services are all barriers to access (11)(12)(13). Other work has investigated facilitators for adolescent use of services such as making Wi-Fi available in waiting rooms at clinics and incentivizing youths in other ways, including money (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

Govathson

Long

Moolla

et al. 2022

Preprint

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Background: Many Adolescents in Sub-Saharan Africa do not access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the students preferences for how services are delivered so that implementation strategies can reflect this. Methods: A discrete choice experiment (DCE) was used to elicit preferences. The DCE was conducted in 10 high schools situated in neighbourhoods of varying socioe-conomic status (SES) in Gauteng (South Africa). Students aged ≥15 years (Grades 9-12) were consented and enrolled in the DCE. Conditional logistic regression was used to determine preferred attributes for HIV and contraceptive service delivery. Results were stratified by gender and neighbourhood SES quintile. (1≡Lowest SES; 5≡Highest SES). Results: The DCE was completed between 07/2018-09/2019; 805 students were enrolled (67% female; 66% 15-17 years; 51% in grades 9-10). 54% of students in quintile 1 schools had no monthly income; 38% in quintile 5 schools had access to USD7 per month. Preferences were similar for male and female students. Students strongly preferred services provided by friendly, non-judgmental staff (Odds ratio 1.63; 95% Confidence Interval: 1.55-1.72) where confidentiality was ensured (1.33; 1.26-1.40). They preferred services offered after school (1.14; 1.04-1.25) with value-added services like free WiFi (1.19; 1.07-1.32), food (1.23; 1.11-1.37) and youth-only waiting areas (1.18; 1.07-1.32). Students did not have a specific location preference, but preferred not to receive services within the community (0.82; 0.74-0.91) or school (0.88; 0.80-0.96). Students attending schools in high SES neighbourhoods expressed a preference for private care (1.15; 0.98-1.35). Costs to access services were a deterrent for most students irrespective of school neighbourhood; female students were deterred by costs ≥USD3 (0.79; 0.70-0.91); males by costs ≥USD7 (0.86; 0.74-1.00) Conclusions: Preferences that encourage utilisation of services do not significantly differ by gender or school neighbourhood SES. Staff attitude and confidentiality are key issues affecting students decisions to access HIV and contraceptive services. Addressing how healthcare providers respond to young people seeking sexual

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

Govathson

Long

Moolla

et al. 2022

Preprint

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“…Quantitative interviews were self‐administered using standardized questionnaires on tablet devices. Available viral load data were extracted from participants’ clinical records in rounds 1 and 2 and linked to their questionnaire data [ 33 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

“…An adapted version of the standardized Patient Medication Adherence Questionnaire was used to assess self‐reported ART adherence in the past week, alongside measures developed in Botswana [ 48 , 49 ]. Adherence was defined by reporting currently taking ART and not having missed any doses in the past 7 days (including weekdays and weekend) [ 34 ]. We included the closest viral load results that were no more than 3 months before or 1 year after the questionnaire interview dates for the respective study rounds.…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative interviews were self-administered using standardized questionnaires on tablet devices. Available viral load data were extracted from participants' clinical records in rounds 1 and 2 and linked to their questionnaire data [33,34]. This analysis was restricted to APHIV (Figure 1) determined by ART initiation age ≤10 years and validated using supporting evidence, such as history of parental death, maternal HIV status and self-reported sexual history [33,35].…”

Section: Study Populationmentioning

confidence: 99%

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Predictors and consequences of HIV status disclosure to adolescents living with HIV in Eastern Cape, South Africa: a prospective cohort study

et al. 2022

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Introduction The World Health Organization recommends full disclosure of HIV‐positive status to adolescents who acquired HIV perinatally (APHIV) by age 12. However, even among adolescents (aged 10–19) already on antiretroviral therapy (ART), disclosure rates are low. Caregivers often report the child being too young and fear of disclosure worsening adolescents’ mental health as reasons for non‐disclosure. We aimed to identify the predictors of disclosure and the association of disclosure with adherence, viral suppression and mental health outcomes among adolescents in sub‐Saharan Africa. Methods Analyses included three rounds (2014–2018) of data collected among a closed cohort of adolescents living with HIV in Eastern Cape, South Africa. We used logistic regression with respondent random‐effects to identify factors associated with disclosure, and assess differences in ART adherence, viral suppression and mental health symptoms between adolescents by disclosure status. We also explored differences in the change in mental health symptoms and adherence between study rounds and disclosure groups with logistic regression. Results Eight hundred and thirteen APHIV were interviewed at baseline, of whom 769 (94.6%) and 729 (89.7%) were interviewed at the second and third rounds, respectively. The proportion aware of their HIV‐positive status increased from 63.1% at the first round to 85.5% by the third round. Older age (adjusted odds ratio [aOR]: 1.27; 1.08–1.48) and living in an urban location (aOR: 2.85; 1.72–4.73) were associated with disclosure between interviews. There was no association between awareness of HIV‐positive status and ART adherence, viral suppression or mental health symptoms among all APHIV interviewed. However, among APHIV not aware of their status at baseline, adherence decreased at the second round among those who were disclosed to ( N = 131) and increased among those not disclosed to ( N = 151) (interaction aOR: 0.39; 0.19–0.80). There was no significant difference in the change in mental health symptoms between study rounds and disclosure groups. Conclusions Awareness of HIV‐positive status was not associated with higher rates of mental health symptoms, or lower rates of viral suppression among adolescents. Disclosure was not associated with worse mental health. These findings support the recommendation for timely disclosure to APHIV; however, adherence support post‐disclosure is important.

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Identifying Adolescents at Highest Risk of ART Non-adherence, Using the World Health Organization-Endorsed HEADSS and HEADSS+ Checklists

Cluver,

Shenderovich,

Seslija

et al. 2023

AIDS Behav

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Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO’s HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities. We used least absolute shrinkage and selection operator variable selection approach with a generalized linear mixed model. HEADSS constructs most predictive were: violence exposure (aOR 1.97, CI 1.61; 2.42, p < 0.001), depression (aOR 1.71, CI 1.42; 2.07, p < 0.001) and being sexually active (aOR 1.80, CI 1.41; 2.28, p < 0.001). Risk of non-adherence rose from 20.4% with none, to 55.6% with all three. HEADSS+ constructs were: medication side effects (aOR 2.27, CI 1.82; 2.81, p < 0.001), low social support (aOR 1.97, CI 1.60; 2.43, p < 0.001) and non-disclosure to parents (aOR 2.53, CI 1.91; 3.53, p < 0.001). Risk of non-adherence rose from 21.6% with none, to 71.8% with all three. Screening within established checklists can improve identification of adolescents needing increased support. Adolescent HIV services need to include side-effect management, violence prevention, mental health and sexual and reproductive health.

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Clinic and care: associations with adolescent antiretroviral therapy adherence in a prospective cohort in South Africa

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 56 publications

School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

Predictors and consequences of HIV status disclosure to adolescents living with HIV in Eastern Cape, South Africa: a prospective cohort study

Identifying Adolescents at Highest Risk of ART Non-adherence, Using the World Health Organization-Endorsed HEADSS and HEADSS+ Checklists

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