“If the mother does not know, there is no way she can tell the adolescent to go for drugs”: Challenges in promoting health and preventing transmission among pregnant and parenting Kenyan adolescents living with HIV

Luseno, Winnie K.; Iritani, Bonita J.; Maman, Suzanne; Mbai, Isabella; Ongili, Barrack; Otieno, Florence Anyango; Hallfors, Denise Dion

doi:10.1016/j.childyouth.2019.05.036

Cited by 11 publications

(21 citation statements)

References 35 publications

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“…Physical health, including sexual and reproductive health Adolescent mothers are less likely to engage and be retained in health services, including antenatal care, HIV testing and adherence to ART and PMTCT Luseno et al, 2019;Ronen et al, 2016). For adolescent mothers who are not living with HIV but reside within endemic areas, HIV exposure and testing remain important for physical health.…”

Section: Health and Well-being Of Adolescent Mothers Affected By Hiv mentioning

confidence: 99%

“…Lila et al found that in Tanzania, some pregnant adolescents did not know about PMTCT and were only tested for HIV at their first visit to the clinic (Lila, 2017). In Kenya, Luseno et al found that adolescents experienced specific risks due to issues around autonomy, consent, and emancipation surrounding their HIV test results and treatment options (Luseno et al, 2019). Estimating rates of access to PMTCT for adolescent mothers is difficult because very few countries in sub-Saharan Africa collect specific large-scale data on PMTCT for adolescent mothers.…”

Section: Health and Well-being Of Adolescent Mothers Affected By Hiv mentioning

confidence: 99%

See 1 more Smart Citation

Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa

Toska

Laurenzi

Roberts

et al. 2020

Global Public Health

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While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.

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Section: Health and Well-being Of Adolescent Mothers Affected By Hiv mentioning

confidence: 99%

Section: Health and Well-being Of Adolescent Mothers Affected By Hiv mentioning

confidence: 99%

Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa

Toska

Laurenzi

Roberts

et al. 2020

Global Public Health

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“…These high rates of LTFU among adolescents are driven by several factors including but not limited to: stigma and discrimination, substance use, school, work and family responsibilities, non‐disclosure of HIV, drug toxicity and high costs of transport to the facility, compounding adolescent concerns about body image, peer pressure, first sexual experience, mental health concerns and developmental changes [ 8 , 50 , 52 ]. Adult clinics do not offer services that are as adolescent‐friendly as paediatric clinics and adolescents may not be ready to be responsible for their own health needs [ 53 , 54 , 55 , 56 ]. We, therefore, recommend targeted support for adolescents and integration of adolescent‐friendly services like mental health services, adolescent sexual and reproductive health across the health system.…”

Section: Discussionmentioning

confidence: 99%

Virologic non‐suppression and early loss to follow up among pregnant and non‐pregnant adolescents aged 15–19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study

et al. 2022

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Introduction Older adolescents aged 15–19 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non‐suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa. Methods We included adolescents aged 15–19 years initiating ART between 2004 and 2019, with ≥ one viral load (VL) measurement between 4 and 24.5 months, and ≥ 6 months follow‐up, from six South African cohorts of the International epidemiology Databases to Evaluate AIDS‐Southern Africa (IeDEA‐SA). We defined VNS as VL ≥400 copies/ml and LTFU as not being in care for ≥180 days from ART start and not known as transferred out of the clinic or dead in the first 24 months on ART. We examined factors associated with VNS and LTFU using Fine&Gray competing risk models. Results We included a total of 2733 adolescents, 415 (15.2%) males, median (IQR) age at ART start of 18.6 (17.3, 19.4) years. Among females, 585/2318 (25.2%) were pregnant. Over the 24‐month follow‐up, 424 (15.5%) of all adolescents experienced VNS: range (11.1% pregnant females and 20.5% males). Over half of all adolescents were LTFU before any other event could occur. The hazard of VNS reduced with increasing age and CD4 count above 200 cells/μl at ART initiation among all adolescents having adjusted for all measured patient characteristics [adjusted sub‐distribution hazard ratio (aSHR) 19 vs. 15 years: 0.50 (95% CI: 0.36, 0.68), aSHR: >500 vs. ≤200 cells/μl: 0.22 (95% CI: 0.16, 0.31)]. The effect of CD4 count persisted in pregnant females. Increasing age and CD4 count >200 cells/μl were risk factors for LTFU among all adolescents. Conclusions Older adolescents had a high risk of LTFU shortly after ART start and a low risk of VNS, especially those initiating treatment during pregnancy. Interventions addressing adherence and retention should be incorporated into adolescent‐friendly services to prevent VNS and LTFU and endeavour to trace lost adolescents as soon as they are identified.

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“…Additionally, consistent with national guidelines for HIV testing [ 31 ], adolescent minors were required to have a parent or guardian over the age of 18 in the vicinity during HIV testing and privacy and confidentiality were strictly adhered to regardless of testing venue. Additionally, on the basis of earlier work [ 39 , 40 ], each adolescent participant was given an opportunity to decide whether their test result would be disclosed to them while their supporting adult was present or given to their supporting adult separately. Adolescents aged 18–19 were encouraged but not required to have a supportive adult with them.…”

Section: Discussionmentioning

confidence: 99%

Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya

Luseno

Field

Iritani

et al. 2022

IJERPH

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Ethical concerns about risks to minor adolescents participating in HIV prevention research is a barrier to their inclusion. One concern is whether HIV testing and results disclosure venue affects the health and behavior of adolescent participants. We assessed for differential effects on quality of life (QOL), depressive symptoms, and sexual behavior due to (1) testing venue (home or health facility) and (2) test result (HIV-positive, HIV-negative, indeterminate). We collected data at three timepoints (baseline, 2-month follow-up, 12-month follow-up) from 113 Kenyan adolescents aged 15–19 (51% female). We analyzed the data using linear mixed effects models for the QOL and depressive symptoms outcomes and a logistic model for the sexual behavior outcome. Results showed a small mental health benefit for adolescents tested for HIV at a health facility compared with home. There was little evidence that testing venue influenced sexual behavior or that test results moderated the effects of HIV testing across all outcomes. The decision to conduct HIV testing at home or a health facility may not be very consequential for adolescents’ health and behavior. Findings underscore the need to critically examine assumptions about adolescent vulnerability to better promote responsible conduct of HIV prevention research with youth in sub-Saharan Africa.

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“If the mother does not know, there is no way she can tell the adolescent to go for drugs”: Challenges in promoting health and preventing transmission among pregnant and parenting Kenyan adolescents living with HIV

Cited by 11 publications

References 35 publications

Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa

Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa

Virologic non‐suppression and early loss to follow up among pregnant and non‐pregnant adolescents aged 15–19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study

Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya

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