Review: An urgent need for research on factors impacting adherence to and retention in care among HIV‐positive youth and adolescents from key populations

Abstract

IntroductionThe 50% increase in HIV-related deaths in youth and adolescents (aged 10–24) from 2005 to 2012 highlights the need to improve HIV treatment and care in this population, including treatment adherence and retention. Youth and adolescents from key populations or young key populations (YKP) in particular are highly stigmatized and may face additional barrier(s) in adhering to HIV treatment and services. We reviewed the current knowledge on treatment adherence and retention in HIV care among YKP to identify gaps in the literature and suggest future directions to improve HIV care for YKP.MethodsWe conducted a comprehensive literature search for YKP and their adherence to antiretroviral therapy (ART) and retention in HIV care on PsycInfo (Ovid), PubMed and Google Scholar using combinations of the keywords HIV/AIDS, ART, adolescents, young adults, adherence (or compliance), retention, men who have sex with men, transgender, injection drug users, people who inject drugs and prisoners. We included empirical studies on key populations defined by WHO; included the terms youth and adolescents and/or aged between 10 and 24; examined adherence to or retention in HIV care; and published in English-language journals. All articles were coded using NVivo.Results and discussionThe systematic search yielded 10 articles on YKP and 16 articles on behaviourally infected youth and adolescents from 1999 to 2014. We found no studies reporting on youth and adolescents identified as sex workers, transgender people and prisoners. From existing literature, adherence to ART was reported to be influenced by age, access to healthcare, the burden of multiple vulnerabilities, policy involving risk behaviours and mental health. A combination of two or more of these factors negatively impacted adherence to ART among YKP. Collectively, these studies demonstrated that future programmes need to be tailored specifically to YKP to ensure adherence.ConclusionsThere is an urgent need for more systematic research in YKP. Current limited evidence suggests that healthcare delivery should be tailored to the unique needs of YKP. Thus, research on YKP could be used to inform future interventions to improve access to treatment and management of co-morbidities related to HIV, to ease the transition from paediatric to adult care and to increase uptake of secondary prevention methods.

Virological failure among adolescents on ART, Harare City, 2017- a case-control study

“…The increased risk of virological failure among older adolescents could be explained by the developmental milestones gone through by older adolescents in transition to their adulthood as compared to the younger adolescents. These include social, emotional and cognitive changes [25]. …”

Health Technology-Enabled Interventions for Adherence Support and Retention in Care Among US HIV-Infected Adolescents and Young Adults: An Integrative Review

“…Technology-enabled interventions for adherence support have only recently been tested in HIV-infected adolescents and young adults, and although promising, synthesis of the findings from the nine identified primary studies reflects a paucity of published peer-reviewed evidence in the US during the past decade. In fact, the evidence base for adherence interventions and recent trends of intervention research are disproportionate to the needs of this population [23, 35, 36]. Hence, the ability to generate broad recommendations from this review is limited.…”

“…To date, technology-enabled interventions have shown promise for a range of chronic conditions [15], including HIV-in-fected adolescent, young adult, and adult cohorts from domestic and international settings [16–21]. However, much less is known about the impact of health technology-enabled interventions on the HIV care cascade [22] with significant knowledge gaps in research targeting ART adherence and retention outcomes among HIV-infected youth [23]. …”

Triggered Escalating Real-Time Adherence Intervention to Promote Rapid HIV Viral Suppression Among Youth Living With HIV Failing Antiretroviral Therapy: Protocol for a Triggered Escalating Real-Time Adherence Intervention (Preprint)

“…Our research has identified an overall lack of rigorous adherence enhancing research, which has been echoed in a number of recent research syntheses. [5,23] Evidence for effective interventions for YLWH failing ART regimens is even less well represented in the literature. Although agencies and service providers are advised to adopt evidence-based adherence support strategies, there are no strong, rigorously tested interventions to consider.…”

“…[18] Furthermore, evidence suggests using phone-based technology to engage adolescent social support networks may promote optimal engagement in care and adherence to medications. [22,23] A recent study of a phone-based support intervention among nonadherent YLWH found that it was acceptable and feasible among youth and clinic staff. [24] Coaching at clinic visit.…”