Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort

Abstract

Background Many adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors–adolescents infected perinatally who survive without access to lifesaving treatment–remain unidentified and disconnected from heath systems, especially in high-prevalence settings. This study examines differences in educational outcomes for ALHIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for ALHIV. Methods Quantitative interviews with N = 1063 adolescents living with HIV and N = 456 HIV-free community control adolescents (10–19 year olds) included educational experiences (enrolment, fee-free school, school feeding schemes, absenteeism, achievement), physical health, cognitive difficulties, mental health challenges (depression, stigma, and trauma), missing school to attend clinic appointments, and socio-demographic characteristics. Voluntary informed consent was obtained from adolescents and caregivers (when adolescent < 18 years old). Analyses included multivariate logistic regressions, controlling for socio-demographic covariates, and structural equation modelling using STATA15. Results ALHIV reported accessing educational services (enrolment, free schools, school feeding schemes) at the same rates as other adolescents (94, 30, and 92% respectively), suggesting that school is a valuable site for identification. Living with HIV was associated with poorer attendance (aOR = 1.7 95%CI1.1–2.6) and educational delay (aOR1.7 95%CI1.3–2.2). Adolescents who reported educational delay were more likely to be older, male, chronically sick and report more cognitive difficulties. A path model with excellent model fit (RMSEA = 0.027, CFI 0.984, TLI 0.952) indicated that living with HIV was associated with a series of poor physical, mental and cognitive health issues which led to worse educational experiences. Conclusion Schools may provide an important opportunity to identify unreached adolescents living with HIV and link them into care, focusing on adolescents with poor attendance, frequent sickness, low mood and slow learning. Key school-based markers for identifying unreached adolescents living with HIV may be low attendance, frequent sickness, low mood and slow learning. Improved linkages to care for adolescents living with HIV, in particular educational support services, are necessary to support scholastic achievement and long-term well-being, by helping them to cope with physical, emotional and cognitive difficulties.

School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

“…In the TEEWA survey, school attendance was high, above 85%, for both ALPHIV and controls, in the upper range compared to other studies in various age groups (8)(9)(10)(11)(12)14). However, among adolescents living in family settings, school attendance was lower among ALPHIV than among general population controls (83% vs. 94%, respectively).…”

“…Studies carried out in low-income countries also found a significant association between HIV-infection and disrupted schooling after adjustment on socio-economic factors (8,9,14). In a recent study in South Africa, Fotso et al found that HIV-infection significantly reduced adolescent school attainment and that contextual factors could only explain 18% of the attainment gap (8).…”

“…In a recent study in South Africa, Fotso et al found that HIV-infection significantly reduced adolescent school attainment and that contextual factors could only explain 18% of the attainment gap (8). While neurocognitive impairments connected to HIV-infection can directly impact academic achievements, school absenteeism for frequent illness or HIV-related stigmatization could mediate the negative effect of HIV-infection on school life (6,11,12,14). In the TEEWA survey, about 20% of ALPHIV mentioned episodes or extended periods of school absenteeism for medical reasons.…”

“…Perinatally HIV-infected children and adolescents often experience difficult living circumstances, such as parental loss, foster care, poverty and stigmatization, which can also have a negative impact on their educational achievements (6). However, studies on their educational achievements are heterogeneous in terms of age groups, study populations, access to ART, outcomes and comparison group (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Cross-Sectional Analysis of Cognitive And Functional Difficulties Among Adolescents Living With HIV In Low-Resourced Settings: Can A Simple Screening Algorithm Identify Adolescents For Support?

“…Consequently, 10-19-year-old apparently HIV-negative adolescents who were either living in the same home or a neighbouring home were also interviewed. HIV status was ascertained using a sequential elimination process (34). Firstly, we searched patient les and Tier.net records in all participating health facilities.…”