Examining the relationship of social support and family cohesion on ART adherence among HIV-positive adolescents in southern Uganda: baseline findings

Damulira, Christopher; Mukasa, Miriam N.; Byansi, William; Nabunya, Proscovia; Kivumbi, Apollo; Namatovu, Phionah; Namuwonge, Flavia; Dvalishvili, Daji; Bahar, Ozge Sensoy; Ssewamala, Fred M.

doi:10.1080/17450128.2019.1576960

Cited by 70 publications

(71 citation statements)

References 34 publications

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“…Several studies have documented the role of social support, especially from family members in influencing adherence outcomes [30][31][32][33][34][35][36][37][38]. For example, a meta-analysis of studies examining social support and patient adherence to medication showed that ART adherence was 1.74 times higher in patients from cohesive families and 1.53 times lower in patients from families experiencing conflict [30].…”

Section: Social Support and Adherencementioning

confidence: 99%

“…For example, a meta-analysis of studies examining social support and patient adherence to medication showed that ART adherence was 1.74 times higher in patients from cohesive families and 1.53 times lower in patients from families experiencing conflict [30]. In Uganda, family cohesion and social support from caregivers/family were associated with self-reported adherence to ART among HIV-infected adolescents [31]. In another study examining the benefits of family and social relationships for health and mental health of PLWH, family functioning significantly contributed to ART adherence and quality of life [32].…”

Section: Social Support and Adherencementioning

confidence: 99%

“…Despite the unique developmental needs of children and adolescents, few studies have specifically focused on family systems among HIV-infected children and adolescents in SSA [31,34,35]. Moreover, these studies do not explicitly explore the relationship between family support and adherence self-efficacy -two factors that are critical to HIV management and adherence to treatment protocols among PLWH, including children and adolescents [36].…”

Section: Social Support and Adherencementioning

confidence: 99%

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The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda

et al. 2020

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Background: Adolescents living with HIV in sub-Saharan Africa are a vulnerable group at the intersection of poverty and health disparities. The family is a vital microsystem that provides financial and emotional support to achieve optimal antiretroviral therapy (ART) adherence. In this study, we explore the association between family factors and ART adherence self-efficacy, a significant psychological concept playing a critical role in ART adherence. Methods: Data from an NIH-funded study called Suubi + Adherence, an economic empowerment intervention for HIV positive adolescents (average age = 12.4 years) in southern Uganda was analyzed. We conducted multilevel regression analyses to explore the protective family factors, measured by family cohesion, child-caregiver communication and perceived child-caregiver support, associated with ART adherence self-efficacy. Results: The average age was 12.4 years and 56.4% of participants were female. The average household size was 5.7 people, with 2.3 children> 18 years. Controlling for sociodemographic and household characteristics, family cohesion (β = 0.397, p = 0.000) and child-caregiver communication (β = 0.118, p = 0.026) were significantly associated with adherence self-efficacy to ART. Conclusion: Findings point to the need to strengthen family cohesion and communication within families if we are to enhance adherence self-efficacy among adolescents living with HIV. Trial registration: This trial was registered with ClinicalTrials.gov (registration number: NCT01790373) on 13 February 2013.

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Section: Social Support and Adherencementioning

confidence: 99%

Section: Social Support and Adherencementioning

confidence: 99%

Section: Social Support and Adherencementioning

confidence: 99%

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The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda

et al. 2020

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“…Testing programmes are often focused on the clinical urgency of testing and on achieving targets such as the UNAIDS 90-90-90 targets, without considering social and relational issues. Notably, there has been much more attention paid to these issues for supporting adherence to treatment in children and adolescents through the provision of social and community based psychosocial support [24,25]. We argue that a similar approach must be adopted for improving uptake of HIV testing, and HIV testing must be regarded as a process rather than a discrete event [26].…”

Section: Discussionmentioning

confidence: 99%

“…I have seen other people die when they are not taking ART. So… I would rather have my child tested so that we know the way forward than to stay in the oblivion age where he/she doesn't know what is going on" [Provider #6,Female,24] Caregivers stated that these factors would impede uptake of HIV testing for children but, importantly, they emphasized that they needed both time and support to work through these concerns and reported that feeling under pressure to quickly move to testing was not conducive to uptake.…”

Section: Limited Paediatric Hiv Literacymentioning

confidence: 99%

Addressing the Challenges and Relational Aspects of Index-Linked HIV testing for Children and Adolescents: Insights From The B-GAP Study in Zimbabwe

Chikwari

Bernays

Dringus

et al. 2020

Preprint

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Introduction Index-linked HIV testing, targeted at sexual contacts or children of individuals with HIV, may improve yield and efficiency. The B-GAP study evaluated index-linked testing approaches in health facility and community-based settings. This paper reports on a qualitative study to understand factors that affect index-linked HIV testing for children and adolescents.Methods We conducted four focus group discussions (FGDs) with caregivers who had their children tested through B-GAP and one FGD with providers who offered index-linked HIV testing to indexes. We aimed to understand enabling and inhibiting factors in the decision-making process. Translated and transcribed transcripts were read for familiarisation. Following initial coding, analytical memos were written to identify emerging key themes across the data.Results Caregivers did not have adequate knowledge about the need for, and importance of, paediatric HIV testing. Once the decision to test had been made, access to facilities was sometimes challenging, and alleviated by community-based testing. A key finding was that HIV testing is not a discrete event but a process that was influenced by relationships with other family members and children themselves. These relationships raised complex issues that could prevent or delay the testing process. Conclusion There is a need to improve paediatric HIV literacy and to provide support to caregivers and their families in order to improve testing uptake. Addressing access barriers through the provision of community-based testing and implementing a family centred approach can optimize index-linked testing. Contributions to the literature • Although promoted and recommended by the World Health Organization; index-linked HIV testing for children has not been standard practice in routine HIV care for many countries including Zimbabwe.• Prior this study, no study has evaluated the factors that influence and affect uptake of index-linked HIV testing for children and adolescents as reported in our manuscript. • Our findings have the potential to bridge the HIV testing gap for children and optimize index-linked testing, a strategy that has been shown to result in higher yield of HIV when compared to universal testing but where uptake remains suboptimal.

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Understanding patterns of family support and its role on viral load suppression among youth living with HIV aged 15 to 24 years in southwestern Uganda

Nakandi

Kiconco

Musiimenta

et al. 2022

Health Science Reports

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Background Active family support helps as a buffer against adverse life events associated with antiretroviral therapy (ART) uptake and adherence. There is limited data available to explain how family support shapes and affects individual healthcare choices, decisions, experiences, and health outcomes among youth living with HIV (YLWH). We aimed to describe family support patterns and its role in viral load suppression among YLWH at a rural hospital in southwestern Uganda. Methods We performed a mixed‐method cross‐sectional study between March and September 2020, enrolling 88 eligible YLWH that received ART for at least 6 months. Our primary outcome of interest was viral load suppression, defined as a viral load detected of ≤500 copies/mL. Data analysis was performed using Statistical Package for Social Sciences version 20. Fifteen individuals were also purposively selected from the original sample and participated in an in‐depth interview that was digitally recorded. Generated transcripts were coded and categories generated manually using the inductive content analytic approach. All participants provided written consent or guardian/parent assent (those <18 years) to participate in the study. Results Forty‐nine percent of YLWH were females, the median age was 21 (IQR: 16‐22) years. About half of the participants (53%) stayed with a family member. A third (34%) of participants had not disclosed their status to any person they stayed with at home. Only 23% reported getting moderate to high family social support (Median score 2.3; IQR: 1.6‐3.2). Seventy‐eight percent of YLWH recorded viral load suppression. Viral load suppression was associated with one living with a parent, sibling, or spouse (AOR: 6.45; 95% CI: 1.16‐16.13; P = .033), having a primary caretaker with a regular income (AOR: 1.57; 95% CI: 1.09‐4.17; P = .014), and living or communicating with family at least twice a week (AOR: 4.2; 95% CI: 1.65‐7.14; P = .003). Other significant factors included youth receiving moderate to high family support (AOR: 12.11; 95% CI: 2.06‐17.09; P = .006) and those that perceived family support in the last 2 years as helpful (AOR: 1.98; 95% CI: 1.34‐3.44; P = .001). HIV stigma (AOR: 0.10; 95% CI: 0.02‐0.23; P = .007) and depression (AOR: 0.31; 95% CI: 0.06‐0.52; P = .041) decreased viral load suppression. Qualitative data showed that dysfunctional family relationships, economic insecurity, physical separation, HIV‐ and disclosure‐related stigma, past and ongoing family experiences with HIV/ART affected active family support. These factors fueled feelings of abandonment, helplessness, discrimination, and economic or emotional strife among YLWH. Conclusion Our data showed that living with a family member, having a primary caretaker with a regular income, living or communicating with family members regularly, and reporting good family support were associated with viral load suppression among YLWH in rural southwestern Uganda. Experiencing depression due to HIV and or disclosure‐related stigma was associated with incr...

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Examining the relationship of social support and family cohesion on ART adherence among HIV-positive adolescents in southern Uganda: baseline findings

Cited by 70 publications

References 34 publications

The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda

The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda

Addressing the Challenges and Relational Aspects of Index-Linked HIV testing for Children and Adolescents: Insights From The B-GAP Study in Zimbabwe

Understanding patterns of family support and its role on viral load suppression among youth living with HIV aged 15 to 24 years in southwestern Uganda

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