Psychological well-being and adherence to antiretroviral therapy among adolescents living with HIV in Zambia

Okawa, Sumiyo; Kabaghe, Sylvia Mwanza; Mwiya, Mwiya; Kikuchi, Kimiyo; Jimba, Masamine; Kankasa, Chipepo; Ishikawa, Naoko

doi:10.1080/09540121.2018.1425364

Cited by 37 publications

(64 citation statements)

References 35 publications

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“…We found that treatment regimens were far more likely to be successful when they were developed in consultation with individual young people themselves [6,21,23,43]. This may be achieved by eliciting and seriously considering the priorities of ALHIV, such as preserving secrecy of their HIV‐positive status, engaging in education and employment opportunities, establishing peer and intimate relationships, and maintaining realistic hope for the future [42,44‐47]. Treatment plans should be adapted to contextual factors [6,8,23], such as by tailoring scheduled times for treatment‐taking to prevent conflict with school and work commitments.…”

Section: Discussionmentioning

confidence: 99%

“Because we all have to grow up”: supporting adolescents in Uganda to develop core competencies to transition towards managing their HIV more independently

et al. 2020

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Introduction Sustaining optimal adherence is the major challenge facing adolescents living with HIV (ALHIV), particularly in low‐resource settings, where “second‐line” is often the last accessible treatment option. We explored the knowledge and skills adolescents need in order to maintain improved adherence behaviours, and the specific ways clinicians and caregivers may support young people to do so more independently. Methods We conducted individual, in‐depth interviews with 20 ALHIV aged 10 to 18 years in Uganda in 2017 to 2018. All participants had recently commenced second‐line treatment as part of a clinical trial. We used thematic qualitative analysis to examine adherence experiences and challenges while on first‐line therapy, as well as specific supports necessary to optimise treatment‐taking longer‐term. Results Adherence difficulties are exacerbated by relatively rapid shifts from caregiver‐led approaches during childhood, to an expectation of autonomous treatment‐taking with onset of adolescence. For many participants this shift compounded their ongoing struggles managing physical side effects and poor treatment literacy. Switching to second‐line typically prompted reversion back to supervised adherence, with positive impacts on self‐reported adherence in the immediate term. However, this measure is unlikely to be sustainable for caregivers due to significant caregiver burden (as on first line), and provided little opportunity for clinicians to guide and develop young people’s capacity to successfully adopt responsibility for their own treatment‐taking. Conclusions As ALHIV in sub‐Saharan Africa are attributed increasing responsibility for treatment adherence and HIV management, they must be equipped with the core knowledge and skills required for successful, self‐directed care. Young people need to be relationally supported to develop necessary “adherence competencies” within the supportive framework of a gradual “transition” period. Clinic conversations during this period should be adolescent‐focussed and collaborative, and treatment‐taking strategies situated within the context of their lived environments and support networks, to facilitate sustained adherence. The disclosure of adherence difficulties must be encouraged so that issues can be identified and addressed prior to treatment failure.

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Section: Discussionmentioning

confidence: 99%

“Because we all have to grow up”: supporting adolescents in Uganda to develop core competencies to transition towards managing their HIV more independently

et al. 2020

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“…Of the ten quantitative studies ( Table 2), five were conducted in southern Africa: South Africa [90,91], Namibia [92], Malawi [93], Zambia [94] ( Table 3). The remainder conducted in eastern Africa: Uganda (n = 2) [95,96], Kenya (n = 1) [97], Ethiopia (n = 1) [98] and Tanzania (n = 1) [99].…”

Section: Quantitative Studies-characteristics and Data Synthesismentioning

confidence: 99%

“…iii. Psycho-social HIV-related stigma was strongly positively associated with poor mental health functioning in six studies [91,92,94,96,98,99]. Among these studies, the largest effect of stigma was documented in Zambia, which found that the odds of having higher depressive symptom scores was almost three times higher for YPLHIV who experienced stigma than in those who did not (aOR = 2.99; 95% CI [1.07-8.41], p = 0.01) [94].…”

Section: Demographicsmentioning

confidence: 99%

“…Psycho-social HIV-related stigma was strongly positively associated with poor mental health functioning in six studies [91,92,94,96,98,99]. Among these studies, the largest effect of stigma was documented in Zambia, which found that the odds of having higher depressive symptom scores was almost three times higher for YPLHIV who experienced stigma than in those who did not (aOR = 2.99; 95% CI [1.07-8.41], p = 0.01) [94]. Having someone to talk to or feeling satisfied with health services or the social support received promoted positive mental health functioning in four studies (Namibia (n = 1) [92], Uganda (n = 2) [95,96], Zambia (n = 1) [94].…”

Section: Demographicsmentioning

confidence: 99%

“…Among these studies, the largest effect of stigma was documented in Zambia, which found that the odds of having higher depressive symptom scores was almost three times higher for YPLHIV who experienced stigma than in those who did not (aOR = 2.99; 95% CI [1.07-8.41], p = 0.01) [94]. Having someone to talk to or feeling satisfied with health services or the social support received promoted positive mental health functioning in four studies (Namibia (n = 1) [92], Uganda (n = 2) [95,96], Zambia (n = 1) [94]. In an Ethiopian study, Abebe, Shumet [98] reported that those with low social support were 2.74 times more likely to develop depressive symptoms than those with strong social support (95% CI [1.42-5.27], p = < 0.01).…”

Section: Demographicsmentioning

confidence: 99%

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Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review

Govindasamy

Seeley

Olaru

et al. 2020

Health Qual Life Outcomes

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Young people living with HIV (YPLHIV) in sub-Saharan Africa (SSA) are at high risk of having a poor quality of life. Addressing wellbeing explicitly within HIV/AIDS policies could assist mitigation efforts. However, guidance on wellbeing measures to evaluate policies for YPLHIV is scarce. The aims of this mixed-methods review were to identify: i) key dimensions of wellbeing and ii) wellbeing measures that align to these dimensions among YPLHIV (15-24 years) in SSA. We searched six social science and medical databases, including grey literature. We included studies that examined correlates and lived experiences of wellbeing, among YPLHIV in SSA, from January 2000 to May 2019. Two reviewers independently screened abstracts and full texts and assessed methodological quality of included articles. We analysed quantitative and qualitative data using descriptive and meta-ethnographic approaches, respectively. Thereafter, we integrated findings using a framework approach. We identified 6527 citations. Of these, 10 quantitative and 30 qualitative studies were included. Being male, higher educational status, less stigma and more social support were likely correlates of wellbeing. Themes that shaped experiences suggestive of wellbeing were: 1) acceptance and belonging-stigma, social support; 2) coping; 3) standard of living. Our final synthesis found that the following dimensions potentially characterise wellbeing: self-acceptance, belonging, autonomy; positive relations, environmental mastery, purpose in life. Wellbeing for YPLHIV is multi-dimensional and relational. Relevant measures include the Personal Wellbeing Index, Ryff's Psychological Wellbeing Scale and Mental Health Continuum Short Form. However, psychometric evaluations of these scales among YPLHIV in SSA are needed.

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Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa

Haas

Technau

Pahad

et al. 2020

J. Intern. AIDS Soc.

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Introduction Mental health problems are prevalent in adolescents living with HIV (ALHIV), often remain untreated, and may negatively affect antiretroviral therapy (ART) adherence and viral suppression. We implemented routine mental health screening at a paediatric ART clinic to improve the identification and management of mental health problems in ALHIV. In this report, we examine screening outcomes, associated patient characteristics and the odds of unsuppressed viral load in ALHIV screening positive for mental disorders. Methods Adolescents aged 10 to 19 years attending Rahima Moosa Hospital in Johannesburg, South Africa between February 1, 2018, and January 1, 2020, were offered mental health screening at each routine HIV care visit. The screening included four pre‐screening questions followed by full screening (conditional on positive pre‐screening) for depression (Patient Health Questionnaire‐9 [PHQ‐9]), suicide (Adolescent Innovations Project [AIP]‐handbook), anxiety (Generalized Anxiety Disorder‐7 [GAD‐7]), post‐traumatic stress disorder (PTSD) (Primary Care PTSD Screen [PC‐PTSD‐5]) and substance use (CAGE Adapted to Include Drugs [CAGE‐AID]). We assessed screening outcomes and calculated adjusted odds ratios for associations between positive screening tests at the first screen and unsuppressed viral load (>400 copies/mL) at the measurement taken closest to the date of screening, within hundred days before and one day after screening. Results Out of 1203 adolescents who attended the clinic, 1088 (90.4%) were pre‐screened of whom 381 (35.0%) underwent full screening, 48 (4.4%) screened positive for depression (PHQ‐9 ≥10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD‐7 ≥10), 38 (3.2%) for PTSD (PC‐PTSD‐5 ≥3), 18 (1.7%) for substance use (CAGE‐AID ≥2) and 97 (8.9%) for any of these conditions. Positive screening for depression (aOR 2.39, 95% CI 1.02 to 5.62), PTSD (aOR 3.18, 95% CI 1.11 to 9.07), substance use (aOR 7.13, 95% CI 1.60 to 31.86), or any condition (aOR 2.17, 95% CI 1.17 to 4.02) were strongly associated with unsuppressed viral load. Conclusions ALHIV affected by mental health problems have increased rates of unsuppressed viral load and need specific clinical attention. The integration of routine mental health screening in paediatric ART programmes is a feasible approach for identifying and referring adolescents with mental health and adherence problems to counselling and psychosocial support services and if needed to psychiatric care.

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Psychological well-being and adherence to antiretroviral therapy among adolescents living with HIV in Zambia

Cited by 37 publications

References 35 publications

“Because we all have to grow up”: supporting adolescents in Uganda to develop core competencies to transition towards managing their HIV more independently

“Because we all have to grow up”: supporting adolescents in Uganda to develop core competencies to transition towards managing their HIV more independently

Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review

Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa

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