The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda

Abstract

Background: Adolescents living with HIV in sub-Saharan Africa are a vulnerable group at the intersection of poverty and health disparities. The family is a vital microsystem that provides financial and emotional support to achieve optimal antiretroviral therapy (ART) adherence. In this study, we explore the association between family factors and ART adherence self-efficacy, a significant psychological concept playing a critical role in ART adherence. Methods: Data from an NIH-funded study called Suubi + Adherence, an economic empowerment intervention for HIV positive adolescents (average age = 12.4 years) in southern Uganda was analyzed. We conducted multilevel regression analyses to explore the protective family factors, measured by family cohesion, child-caregiver communication and perceived child-caregiver support, associated with ART adherence self-efficacy. Results: The average age was 12.4 years and 56.4% of participants were female. The average household size was 5.7 people, with 2.3 children> 18 years. Controlling for sociodemographic and household characteristics, family cohesion (β = 0.397, p = 0.000) and child-caregiver communication (β = 0.118, p = 0.026) were significantly associated with adherence self-efficacy to ART. Conclusion: Findings point to the need to strengthen family cohesion and communication within families if we are to enhance adherence self-efficacy among adolescents living with HIV. Trial registration: This trial was registered with ClinicalTrials.gov (registration number: NCT01790373) on 13 February 2013.

Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health

“…The social support and community mobilization approaches for the management of HIV/AIDS, as opposed to individual-level approaches alone, have been shown to improve antiviral medication adherence [9]. However, due to the enforcement of social distancing and other restrictions in the current pandemic, there has been a shift in the mechanism by which PLHIV receive such social support.…”

“…It is imperative to explore and monitor the adequacy of the current guidelines for the management of PLHIV with other underlying comorbidities. However, ensuring PLHIV have access to their antiviral refills, as well as the maintenance of their social support including material and mental support from community, family, and friends [9] may pose a challenge; hence, the need for the establishment of proper linkage to care. Additionally, PLHIV in LMIC and rural areas may experience additional barriers that inhibit access to care such as the lack of adequate technology for telemedicine, lack of transportation to open clinics, and additional costs and complexity required to provide care during the current pandemic.…”

“…In order to curtail future transmission of COVID-19, health and city officials need to consider the impact of homelessness and unemployment as possible drivers of the spread of infection. Effective communication, financial resources, food insecurity, management of chronic diseases, respite care, personal protection, and housing [9] are issues that should be addressed among this vulnerable population.…”

The secret life of young adolescents living with HIV in northern Mozambique - a mixed methods study

“…Evidence from previous studies indicate that older adolescence is a risk factor for suboptimal adherence due to various factors [30][31][32][33][34], but our participants expect that pill intake will become easier as they grow older and become more independent from their caregivers. Hence, programs to improve ART outcomes in this population would benefit from working on two fronts: engaging caregivers to empower them to extend their support into later adolescence [35,36] and preparing young adolescents to develop disease management skills when caregiver support will no longer be available [37]. Longacting ART formulations may play a particularly important role for this population when they become available.…”

Non-adherence to Antiretroviral Treatment Episodes and Contributing Factors among Fully Disclosed Adolescents with Perinatal HIV in the Kingdom of Lesotho

“…Hawkins et al [1] describe situational adherence patterns as having a period of adherence and non-adherence within a short period influenced largely by factors such as location at the time of dosing, or the time of day when the individual's medication is due. For example, school activities often outweigh clinic appointments and medication refills, which result in non-adherence for a short duration [1,15]. Episodic adherence described as the missed or late doses, treatment interruptions, and discontinuations, and partial dosing leads to suboptimal ART adherence [16].…”