Service Use and Resilience among Adolescents Living with HIV in Blantyre, Malawi

Kaunda-Khangamwa, Blessings N.; Maposa, Innocent; Phiri, Moffo; Malisita, Kennedy; Mtagalume, Emmanuel; Chigaru, Lalio; Munthali, Alister; Chipeta, Effie; Phiri, Sam; Manderson, Lenore

doi:10.5334/ijic.5538

Cited by 4 publications

(5 citation statements)

References 60 publications

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“…Integrated care counters this through therapeutic impartiality, empathy through compassionate care, social support, and appreciative and non-judgmental communication [ 105 ]. Moreover, integrated care aims to promote health literacy with PLWH’s ability to use health services on their own and build resilience and self-efficacy to cope with the complex situation [ 29 , 106 ]. In particular, in remote African countries, life expectancy can be increased by 75 percent compared to people without access to health care [ 98 , 107 ].…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of ART to suppress the viral load dramatically reduces the likelihood of onward transmission, and treatment as prevention is becoming increasingly evident [ 28 , 29 , 30 ]. Using a wide variety of additional diagnoses of PLWH as examples, the data also demonstrate that integrated care reduces hospitalization in the clinical setting and saves high costs faced by health care systems [ 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS

Beichler

Grabovac

Dörner

2023

IJERPH

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Introduction: Today, antiretroviral therapy (ART) is effectively used as a lifelong therapy to treat people living with HIV (PLWH) to suppress viral replication. Moreover, PLWH need an adequate care strategy in an interprofessional, networked setting of health care professionals from different disciplines. HIV/AIDS poses challenges to both patients and health care professionals within the framework of care due to frequent visits to physicians, avoidable hospitalizations, comorbidities, complications, and the resulting polypharmacy. The concepts of integrated care (IC) represent sustainable approaches to solving the complex care situation of PLWH. Aims: This study aimed to describe the national and international models of integrated care and their benefits regarding PLWH as complex, chronically ill patients in the health care system. Methods: We conducted a narrative review of the current national and international innovative models and approaches to integrated care for people with HIV/AIDS. The literature search covered the period between March and November 2022 and was conducted in the databases Cinahl, Cochrane, and Pubmed. Quantitative and qualitative studies, meta-analyses, and reviews were included. Results: The main findings are the benefits of integrated care (IC) as an interconnected, guideline- and pathway-based multiprofessional, multidisciplinary, patient-centered treatment for PLWH with complex chronic HIV/AIDS. This includes the evidence-based continuity of care with decreased hospitalization, reductions in costly and burdensome duplicate testing, and the saving of overall health care costs. Furthermore, it includes motivation for adherence, the prevention of HIV transmission through unrestricted access to ART, the reduction and timely treatment of comorbidities, the reduction of multimorbidity and polypharmacy, palliative care, and the treatment of chronic pain. IC is initiated, implemented, and financed by health policy in the form of integrated health care, managed care, case and care management, primary care, and general practitioner-centered concepts for the care of PLWH. Integrated care was originally founded in the United States of America. The complexity of HIV/AIDS intensifies as the disease progresses. Conclusions: Integrated care focuses on the holistic view of PLWH, considering medical, nursing, psychosocial, and psychiatric needs, as well as the various interactions among them. A comprehensive expansion of integrated care in primary health care settings will not only relieve the burden on hospitals but also significantly improve the patient situation and the outcome of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS

Beichler

Grabovac

Dörner

2023

IJERPH

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“…number of those who had ever had sex, adolescents using STI care, family planning, ever been pregnant); these are presented elsewhere. 51 Most participants were living with perinatally-acquired HIV, and this analysis may not be generalised to adolescents without HIV.…”

Section: Discussionmentioning

confidence: 99%

Ethnographic understandings of sexual and reproductive health and HIV care for adolescents in Blantyre, Malawi

Kaunda-Khangamwa

Munthali

Manderson

2023

Sexual and Reproductive Health Matters

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Sexual and reproductive health (SRH) care and support are provided to adolescents living with HIV, with the aim to build safer sex negotiation skills, sexual readiness and reproductive preparedness while reducing unintended pregnancies and sexually transmitted infections. We consider how different settings might either constrain or facilitate access to resources and support. Ethnographic research was conducted in Malawi in teen club clinic sessions at an enhanced antiretroviral clinic from November 2018 to June 2019. Twenty-one individual and five group interviews were conducted with young people, caregivers, and healthcare workers, and were digitally recorded, transcribed, and translated into English for thematic analysis . Drawing on socio-ecological and resilience theories, we considered the different ways in which homes, schools, teen club clinics, and community settings all functioned as interactional, relational, and transformational spaces to allow young people to talk about and receive information on sexuality and health. Young people perceived that comprehensive SRH support enhanced their knowledge, sexual readiness, and reproductive preparedness. However, their desire to reproduce at an early age complicated their adoption of safer sex negotiation skills and SRH care. Engaging and talking about SRH and related issues varied according to physical and social space, suggesting the value of multiple locations for support and resources for young people with HIV.

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“…In addition to more reliable information, counselling and support models that focus on fortifying adolescents' coping skills and their perceptions of themselves as strong and empowered individuals could help engage them in ongoing HIV care and adherence with ART. (39) Several participants in our study were isolated from their peers. A South African study reported that adolescents valued clinic-based support groups, (40) and there is growing evidence that if run well, clinic-based peer-support groups improve adherence.…”

Section: Discussionmentioning

confidence: 99%

‘If I am playing football, I forget that I have this virus’: The challenges and coping strategies of adolescents with perinatally acquired HIV in KwaZulu-Natal, South Africa

Loveday

Furin

Hlangu

et al. 2022

Preprint

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Background: Adolescents who have acquired HIV perinatally (ALHIV) face unique challenges in taking lifelong antiretroviral therapy (ART), but little is known about what factors affect their adherence over the course of their lifelong treatment journey. Methods: We conducted a qualitative study with ALHIV who had periods of poor adherence to ART in KwaZulu-Natal, South Africa using Participant-generated Visual Methodologies (PVM). Participants used photography to represent their perspectives and experiences. Results: 14 individuals participated in the research process. We developed a framework and identified four social domains which combined with the adolescent’s own experiences and sense of self to either support or undermine adherence. Periods of non-adherence were reported by all participants. Participants described the importance of supportive relationships and households as well as the benefits of ART as supporting adherence. The fear of inadvertent disclosure of their HIV status and the side-effects of ART were barriers to adherence. Possible interventions to support adolescents in their treatment journey are identified.Conclusions: Current models of adherence support fail to address the challenges to lifelong therapy ALHIV face. Ongoing education and honest communication with health care providers, interventions that build resilience together with peer support, have the potential to improve adherence in ALHIV.

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Service Use and Resilience among Adolescents Living with HIV in Blantyre, Malawi

Cited by 4 publications

References 60 publications

Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS

Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS

Ethnographic understandings of sexual and reproductive health and HIV care for adolescents in Blantyre, Malawi

‘If I am playing football, I forget that I have this virus’: The challenges and coping strategies of adolescents with perinatally acquired HIV in KwaZulu-Natal, South Africa

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