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Wiginton JM, Amico KR, Hightow-Weidman L, Sullivan P, Horvath KJ. Syndemic Psychosocial Conditions among Youth Living with HIV: a Latent Class Analysis. AIDS Behav 2024; 28:3498-3511. [PMID: 39017755 PMCID: PMC11427513 DOI: 10.1007/s10461-024-04427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/18/2024]
Abstract
Drug use, mental distress, and other psychosocial factors threaten HIV care for youth living with HIV (YLWH). We aimed to identify syndemic psychosocial patterns among YLWH and examine how such patterns shape HIV outcomes. Using baseline data from 208 YLWH enrolled in an HIV treatment adherence intervention, we performed latent class analysis on dichotomized responses to 9 psychosocial indicators (enacted HIV stigma; clinical depression and anxiety; alcohol, marijuana, and illicit drug misuse; food and housing insecurity; legal history). We used multinomial logistic regression to assess latent class-demographic associations and the automatic Bolck-Croon-Hagenaars method to assess HIV outcomes by class. Mean age of participants was 21 years; two thirds identified as cis male, 60% were non-Hispanic Black, and half identified as gay. Three classes emerged: "Polydrug-Socioeconomic Syndemic" (n = 29; 13.9%), "Distress-Socioeconomic Syndemic" (n = 35, 17.1%), and "Syndemic-free" (n = 142, 69.0%). Older, unemployed non-students were overrepresented in the "Polydrug-Socioeconomic Syndemic" class. Missed/no HIV care appointments was significantly higher in the "Polydrug-Socioeconomic Syndemic" class (81.4%) relative to the "Syndemic-free" (32.8%) and "Distress-Socioeconomic Syndemic" (31.0%) classes. HIV treatment nonadherence was significantly higher in the "Polydrug-Socioeconomic Syndemic" class (88.5%) relative to the "Syndemic-free" class (59.4%) but not the "Distress-Socioeconomic Syndemic" class (70.8%). Lack of HIV viral load suppression was non-significantly higher in the "Polydrug-Socioeconomic Syndemic" class (29.7%) relative to the "Syndemic-free" (16.2%) and "Distress-Socioeconomic Syndemic" (15.4%) classes. Polydrug-using, socioeconomically vulnerable YLWH are at risk for adverse HIV outcomes, warranting tailored programming integrated into extant systems of HIV care.
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Affiliation(s)
- John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Lisa Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
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Dzavakwa NV, Kranzer K, Khan P, Mackworth-Young CRS, Mujuru HA, Ferrand RA, Simms V. Electronic monitoring device informed interventions for treatment adherence and clinical outcomes in children and adolescents: A systematic review. Int J Nurs Stud 2024; 160:104903. [PMID: 39303643 DOI: 10.1016/j.ijnurstu.2024.104903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 09/01/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE To systematically review literature from randomised controlled trials (RCTs) investigating the effectiveness of electronic monitoring device informed interventions on adherence and clinical outcomes in children and adolescents with chronic conditions. STUDY DESIGN A systematic review was conducted. An electronic literature search covering studies, with no pre-specified starting date up to June 2024, was performed in Medline, EMBASE, Web of Science, Cochrane and Trials databases was conducted. PARTICIPANTS RCTs of electronic monitoring device informed interventions in individuals aged 0 to 18 years with chronic conditions, were identified, with no restriction on geography or publication date. METHODS Extracted data was synthesised. As a result of differences in definitions and analysis of adherence and clinical outcomes across the studies a pooled meta-analysis was not possible therefore, a descriptive analysis was conducted. Risk of bias across all studies was assessed using the Cochrane Collaboration risk of bias tool. RESULTS 11 RCTs, with 1485 children and adolescents were included. Studies were all from high- and middle-income countries, conducted among children and adolescents with asthma, and one each among children and adolescents with kidney transplant, multiple sclerosis, and epilepsy. Eight of the 11 studies reported a positive effect on adherence. Only four studies reported a positive effect on clinical outcomes and seven studies found no effect on clinical outcomes. CONCLUSIONS Electronic monitoring device interventions show promise in improving adherence in children and adolescents with chronic conditions, in a limited number of chronic conditions, mostly asthma. Evidence for the efficacy of electronic monitoring device informed interventions on clinical outcomes and from low-income settings is lacking. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022312057, registered in March 2022. TWEETABLE ABSTRACT Electronic monitoring device informed interventions may improve treatment adherence in children and adolescents with chronic conditions but evidence from low-income settings is lacking @nyasha_dzavakwa @KatharinaKranz4 @dopapus @hilda_mujuru @rashida_abbferr @vickysimms_epi.
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Affiliation(s)
- Nyasha V Dzavakwa
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom; The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe.
| | - Katharina Kranzer
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom; Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | - Palwasha Khan
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Constance R S Mackworth-Young
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hilda A Mujuru
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Rashida A Ferrand
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom; The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
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Buchanan AM, Bekker A, Chandasana H, DeMasi R, Lulic Z, Ernest T, Brothers C, Min S, Ruel T, Tan LK. Advancing Research and Development of Anti-infectives for Children: A Clinical Development Perspective. Int J Antimicrob Agents 2024:107306. [PMID: 39146996 DOI: 10.1016/j.ijantimicag.2024.107306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/17/2024] [Accepted: 08/06/2024] [Indexed: 08/17/2024]
Abstract
The HIV treatment landscape for adults has progressed dramatically in recent decades; however, paediatric populations continue to experience delayed and limited access to effective and safe antiretroviral therapy options. Despite current incentive programs, formulation research and development and approved drug dosing for children have been limited, particularly for neonates (aged <4 weeks). Regulatory approval of drug formulations and dosing in children may lag behind adult approvals by years. Formulation and trial design adjustments complicate paediatric drug development, all of which are vital to accommodate for physiological differences, organ maturation, and rapid weight gain, which are most significant in the youngest children. To facilitate more rapid anti-infective drug development for paediatric populations, regulatory agencies provide guidelines that include extrapolating efficacy and safety data from relevant populations; using pharmacokinetic (PK) bridging and modelling to reduce sample sizes and limit the number of PK studies needed before efficacy analyses; and enrolling age- or weight-based cohorts in parallel rather than sequentially for clinical trials. Ensuring access to approved drugs poses an additional challenge, as uncertainty in demand leads to manufacturing and supply complexity with potentially higher costs that can be a barrier to uptake. Here we summarize challenges in drug development for children living with HIV, which are not unique to antiretrovirals. We aim to propose strategies for how model-based approaches and global partnerships can overcome some of these barriers to accelerate paediatric drug development, with particular reference to HIV, and how lessons learnt from HIV could be extended to other anti-infectives.
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Affiliation(s)
- Ann M Buchanan
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, USA 27701.
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | | | - Ralph DeMasi
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, USA 27701.
| | - Zrinka Lulic
- GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS UK.
| | - Terry Ernest
- GSK, Building 5, Park Road, Ware, Herts, SG12 0DP UK.
| | - Cindy Brothers
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, USA 27701.
| | - Sherene Min
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, USA 27701.
| | - Theodore Ruel
- University of California, San Francisco, Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, 550 16th Street, Box 0434, San Francisco, CA, USA 94158.
| | - Lionel K Tan
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS UK.
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Tsondai PR, Davies MA, Singtoroj T, Maxwell N, Technau KG, Chokephaibulkit K, Lumbiganon P, Sohn AH. Creating a data collection and management platform to support measurement of adolescent HIV care transition processes within low- and middle-income countries: The GRADUATE project. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002705. [PMID: 39102384 PMCID: PMC11299826 DOI: 10.1371/journal.pgph.0002705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/10/2024] [Indexed: 08/07/2024]
Abstract
Few national programs and research cohorts within low- and middle-income countries (LMICs) document transition-related processes and outcomes for adolescents and young adults living with HIV (AYLH) transitioning to adulthood. Between 2017-2020, The Global fRAmework of Data collection Used for Adolescent HIV Transition Evaluation (GRADUATE) project convened a collaborative advisory group to identify key variables and definitions capturing the process, predictors, and outcomes across the transition period. In total, 114 variables identified as essential to measuring AYLH transition-related data were identified and formatted into a GRADUATE Data Exchange Standard (DES), which was added to and harmonized with the existing International epidemiology Databases to Evaluate AIDS (IeDEA) DES. In 2019, the GRADUATE DES was pilot tested at four IeDEA facilities in Malawi, South Africa, and Thailand through a cross-sectional study. Upon comparing the variables to routine medical records, available data were too limited to adequately capture transition-related processes and outcomes. However, additional data collection using GRADUATE tools was feasible and improved completeness. Of the 100 (52% female) AYLH included in the pilot study, 71% had transitioned/transferred to adult care, with 42% transitioning from an adolescent-specific model of care within an integrated family clinic to having their clinic visits scheduled on a different day of the week while 58% transferred from a pediatric facility to one offering adult HIV care. While almost all (94%) had a transition-related discussion with their healthcare providers prior to the transition, we found that 69% (95% CI 49-85%) were somewhat or very satisfied/comfortable with the post-transfer clinic and the staff. Utilization of the GRADUATE DES better characterized AYLH transitioning to adulthood across LMICs, and optimally measured transition preparation activities and outcomes. Utilization of the GRADUATE DES in other settings could facilitate comparisons and identify gaps in the care of transitioning adolescents that need to be addressed.
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Affiliation(s)
- Priscilla R. Tsondai
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Thida Singtoroj
- TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand
| | - Nicola Maxwell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Karl-Günter Technau
- Faculty of Health Sciences, Department of Paediatrics & Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Kulkanya Chokephaibulkit
- Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Faculty of Medicine, Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | - Annette H. Sohn
- TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand
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Ahmed CV, Dlamini A, Mbuyisa M, Simelane M, Gallagher D, Golos A, Donworth G, Dubner J, McLain L, Lowenthal ED, Rice BM, Brooks MJ, Buttenheim AM. The NUDGE Framework: Application to Address Behavioral Barriers to Antiretroviral Therapy in Adolescents Living With HIV in Eswatini. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:285-298. [PMID: 39189960 DOI: 10.1521/aeap.2024.36.4.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Behavioral economics offers a unique opportunity to understand the social, cognitive, and psychological nuances that may influence health behavior. The purpose of this article is to demonstrate the application of NUDGE, a novel behavioral economics and design thinking framework, to address barriers to antiretroviral therapy adherence among adolescents living with HIV in eSwatini. NUDGE comprises five steps: (1) Narrow the focus to a specific target behavior, (2) Understand the context of the behavior through inquiry, (3) Discover behavioral insights related to the target behavior, (4) Generate intervention design features to address behavioral barriers to the target behavior, and (5) Evaluate the design features through iterative pilot testing. This article demonstrates the application of the Discover and Generate steps using qualitative data. In showing the utility of the NUDGE framework, we provide a practical tool for creating interventions informed by behavioral insights.
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Affiliation(s)
- Charisse V Ahmed
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ayanda Dlamini
- Baylor College of Medicine - Bristol Myers-Squibb Children's Clinical Centre of Excellence (COE), Mbabane, eSwatini
| | - Majaha Mbuyisa
- Baylor College of Medicine - Bristol Myers-Squibb Children's Clinical Centre of Excellence (COE), Mbabane, eSwatini
| | - Mthobisi Simelane
- Baylor College of Medicine - Bristol Myers-Squibb Children's Clinical Centre of Excellence (COE), Mbabane, eSwatini
| | - Darby Gallagher
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Aleksandra Golos
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Gregory Donworth
- University of Pennsylvania College of Liberal and Professional Studies, Philadelphia, Pennsylvania
| | - Jacob Dubner
- University of Pennsylvania College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Lindsey McLain
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elizabeth D Lowenthal
- University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania
| | - Merrian J Brooks
- University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Aurpibul L, Tangmunkongvorakul A, Detsakunathiwatchara C, Srita A, Masurin S, Meeart P, Chueakong W. "I want to be healthy and move on": A qualitative study of barriers and facilitators to antiretroviral treatment adherence among young adult survivors with perinatal HIV in Thailand. PLoS One 2024; 19:e0305918. [PMID: 39012925 PMCID: PMC11251579 DOI: 10.1371/journal.pone.0305918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 06/06/2024] [Indexed: 07/18/2024] Open
Abstract
We know that HIV treatment outcome depends on antiretroviral treatment (ART) adherence. Young adults with perinatal HIV (YPHIV) who survived have endured various adherence challenges in their adolescent years. While some of them could maintain perfect adherence with sustainable virologic suppression, many experienced one or more episodes of virologic failure. We explored factors affecting ART adherence from real-life experiences of YPHIV. A qualitative study was conducted between June and November 2022. Twenty YPHIV aged 21-29 years with a history of virologic failure and resumed virologic suppression during adolescent years were invited to share their experiences through individual in-depth interviews. Audio records were transcribed verbatim and analyzed using deductive thematic analysis. We divided excerpts into two themes: barriers and facilitators to ART adherence. The socio-ecological model was used to frame subthemes at personal, societal, and healthcare system levels. Most barriers to adherence were concentrated at the personal level, including work/study-related conditions, personal entertainment, medication issues, mental health problems, thought, and belief. At the societal level, social activities and fear of HIV disclosure were frequently mentioned as barriers. Medical care cost was the only identified barrier at the healthcare system level. The facilitators to adherence at the personal level included perceiving health deterioration, being afraid of hospitalization and medical procedures, and wishing to be healthy and move on. At the same time, perceived family support and determination to complete family without HIV transmission were identified as facilitators at the societal level. Service behaviors of healthcare providers were mentioned as facilitators to adherence at the healthcare system level. From this study, most factors associated with non-adherence in adolescents were at the personal level, and the fear of HIV disclosure was critical at the societal level. The key facilitator to adherence was the determination to be healthy and have a promising future. Our findings reinforce the importance of establishing youth-friendly services in the existing HIV care setting. More time allocation for tailored individual counseling, using other novel approaches like mHealth, online media, and involvement of social support from different sectors might be beneficial to maximize adherence self-efficacy during the transitional period of YPHIV.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Angkana Srita
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Supunnee Masurin
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Patcharaporn Meeart
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Walailak Chueakong
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Kelly NK, Rosso MT, Rainer C, Claude K, Muessig KE, Hightow-Weidman L. Discordance Between HIV Risk Perception, Sexual Behavior, and Pre-exposure Prophylaxis Adherence Among Young Sexual and Gender Minorities in the United States. J Adolesc Health 2024; 74:1112-1117. [PMID: 38583158 PMCID: PMC11102322 DOI: 10.1016/j.jadohealth.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE In the United States, youth experience suboptimal HIV pre-exposure prophylaxis (PrEP) adherence. One common idea posits that this is due to their developing decision-making skills. However, quantitative evidence of this assumption is limited. We therefore examined whether individual decision-making factors, such as HIV risk perception and sexual behavior, predicted PrEP adherence in a national trial of young sexual and gender minorities (YSGMs). METHODS In 2019-2021, the Adolescent Medicine Trials Network for HIV Interventions 142 study enrolled 225 PrEP users (ages 16-24) throughout the country. Regression models estimated the associations between HIV risk perception (using a modified Perceived HIV Risk Scale), sexual behavior (condomless anal sex in ≤ 3 months), and self-reported oral PrEP adherence (≥4 pills in the past week) at the same time point (baseline) and longitudinally (3 months). RESULTS Baseline risk perception (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.82, 1.04) and condomless anal sex (RR: 1.10, 95% CI: 0.97, 1.25) were not associated with PrEP adherence at the same time point and did not predict 3-month adherence (RR: 0.97, 95% CI: 0.85, 1.11; RR: 1.05, 95% CI: 0.93, 1.19, respectively). Baseline risk perception was not associated with condomless anal sex at either time point (baseline RR: 1.16, 95% CI: 0.94, 1.43; 3-month RR: 1.07, 95% CI: 0.90, 1.28). DISCUSSION In this national trial of YSGM, HIV risk perception and condomless anal sex did not predict PrEP adherence. Targeting individual-level perceptions and behaviors will likely insufficiently address youth's suboptimal PrEP use. Future research should identify YSGM-specific adherence drivers and train providers to recognize such motivations.
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Affiliation(s)
- Nicole K Kelly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Matthew T Rosso
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Crissi Rainer
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Kristina Claude
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Kathryn E Muessig
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Lisa Hightow-Weidman
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
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Zhou S, Cluver L, Knight L, Edun O, Sherman G, Toska E. Longitudinal Trajectories of Antiretroviral Treatment Adherence and Associations With Durable Viral Suppression Among Adolescents Living With HIV in South Africa. J Acquir Immune Defic Syndr 2024; 96:171-179. [PMID: 38771754 PMCID: PMC11115368 DOI: 10.1097/qai.0000000000003408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/20/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Compared with other age groups, adolescents living with HIV (ALHIV) are estimated to have lower levels of adherence to antiretroviral treatment. Despite this, we lack evidence on adolescents' adherence patterns over time to inform the customization of intervention strategies. SETTING Eastern Cape province, South Africa. METHODS We analyzed data from a cohort of ALHIV (N = 1046, aged 10-19 years at baseline) recruited from 53 public health facilities. The cohort comprised 3 waves of data collected between 2014 and 2018 and routine viral load data from the National Institute for Communicable Disease data warehouse (2014-2019). Durable viral suppression was defined as having suppressed viral load (<1000 copies/mL) at ≥2 consecutive study waves. Group-based multitrajectory model was used to identify adherence trajectories using 5 indicators of self-reported adherence. Logistic regression modeling evaluated the associations between adherence trajectories and durable viral suppression. RESULTS Overall, 933 ALHIV (89.2%) completed all 3 study waves (55.1% female, mean age: 13.6 years at baseline). Four adherence trajectories were identified, namely, "consistent adherence" (49.8%), "low start and increasing" (20.8%), "gradually decreasing" (23.5%), and "low and decreasing" (5.9%). Adolescents experiencing inconsistent adherence trajectories were more likely to be older, live in rural areas, and have sexually acquired HIV. Compared with the consistent adherence trajectory, the odds of durable viral suppression were lower among adolescents in the low start and increasing (adjusted odds ratio [aOR]: 0.62, 95% CI: 0.41 to 0.95), gradually decreasing (aOR: 0.40, 95% CI: 0.27 to 0.59), and the low and decreasing adherence (aOR: 0.25, 95% CI: 0.10 to 0.62) trajectories. CONCLUSIONS Adherence to antiretroviral treatment remains a challenge among ALHIV in South Africa. Identifying adolescents at risk of nonadherence, based on their adherence trajectories may inform the tailoring of adolescent-friendly support strategies.
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Affiliation(s)
- Siyanai Zhou
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa & Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom & Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa & School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Olanrewaju Edun
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Gayle Sherman
- Centre for HIV and STIs, National Institute of Communicable Diseases, a division of the National Health Laboratory Service, South Africa & Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa & Department of Sociology, University of Cape Town, Cape Town, South Africa
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Leonard A, Duroseau B. Overview of the Epidemiology and Clinical Care Considerations for Adolescents and Young Adults Living with or at Risk of Human Immunodeficiency Virus. Nurs Clin North Am 2024; 59:329-344. [PMID: 38670698 PMCID: PMC11058420 DOI: 10.1016/j.cnur.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
This article provides an updated examination of human immunodeficiency virus (HIV) epidemiologic trends among adolescents and young adults (AYAs) in the United States, highlighting the significant public health challenge posed by HIV within this demographic. Despite a notable decline in HIV diagnoses among AYAs, challenges remain, particularly due to 50% of AYAs living with HIV being unaware of their status. The article aims to evaluate current clinical recommendations, identify deficiencies, and propose evidence-based improvements for HIV prevention, diagnosis, and care, with the goal of enhancing health outcomes and reducing HIV prevalence among AYAs.
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Affiliation(s)
- Adam Leonard
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA; Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA.
| | - Brenice Duroseau
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA. https://twitter.com/thenpthatcares
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Hall AL, Naar S, Outlaw AY, Templin T, Green Jones M, MacDonell KK. Factors Impacting the Treatment Readiness of Youth Starting Antiretroviral Treatment in the United States. AIDS Patient Care STDS 2024; 38:249-251. [PMID: 38742985 PMCID: PMC11301701 DOI: 10.1089/apc.2024.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Affiliation(s)
- Amy Lee Hall
- Center for Translational Behavioral Research, Florida State University, Tallahassee, Florida, USA
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Sylvie Naar
- Center for Translational Behavioral Research, Florida State University, Tallahassee, Florida, USA
| | - Angulique Yvette Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Monique Green Jones
- Department of Public Health, College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan, USA
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Seng R, Frange P, Faye A, Dollfus C, le Chenadec J, Boufassa F, Essat A, Goetghebuer T, Arezes E, Avettand-Fènoël V, Bigna JJ, Blanche S, Goujard C, Meyer L, Warszawski J, Viard JP. Immunovirological status in people with perinatal and adult-acquired HIV-1 infection: a multi-cohort analysis from France. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100885. [PMID: 38576825 PMCID: PMC10993179 DOI: 10.1016/j.lanepe.2024.100885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
Background No study has compared the virological and immunological status of young people with perinatally-acquired HIV infection (P-HIV) with that of people with HIV adulthood (A-HIV) having a similar duration of infection. Methods 5 French cohorts of P-HIV and A-HIV patients with a known date of HIV-infection and receiving antiretroviral treatment (ART), were used to compare the following proportions of: virological failure (VF) defined as plasma HIV RNA ≥ 50 copies/mL, CD4 cell percentages and CD4:CD8 ratios, at the time of the most recent visit since 2012. The analysis was stratified on time since infection, and multivariate models were adjusted for demographics and treatment history. Findings 310 P-HIV were compared to 1515 A-HIV (median current ages 20.9 [IQR:14.4-25.5] and 45.9 [IQR:37.9-53.5] respectively). VF at the time of the most recent evaluation was significantly higher among P-HIV (22.6%, 69/306) than A-HIV (3.3%, 50/1514); p ≤ 0.0001. The risk of VF was particularly high among the youngest children (2-5 years), adolescents (13-17 years) and young adults (18-24 years), compared to A-HIV with a similar duration of infection: adjusted Odds-Ratio (aOR) 7.0 [95% CI: 1.7; 30.0], 11.4 [4.2; 31.2] and 3.3 [1.0; 10.8] respectively. The level of CD4 cell percentages did not differ between P-HIV and A-HIV. P-HIV aged 6-12 and 13-17 were more likely than A-HIV to have a CD4:CD8 ratio ≥ 1: 84.1% vs. 58.8% (aOR = 3.5 [1.5; 8.3]), and 60.9% vs. 54.7% (aOR = 1.9 [0.9; 4.2]) respectively. Interpretation P-HIV were at a higher risk of VF than A-HIV with a similar duration of infection, even after adjusting for treatment history, whereas they were not at a higher risk of immunological impairment. Exposure to viral replication among young patients living with HIV since birth or a very early age, probably because of lower adherence, could have an impact on health, raising major concerns about the selection of resistance mutations and the risk of HIV transmission. Funding Inserm - ANRS MIE.
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Affiliation(s)
- Rémonie Seng
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Pierre Frange
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - Albert Faye
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Catherine Dollfus
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
| | | | - Faroudy Boufassa
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Asma Essat
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Tessa Goetghebuer
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université Libre de Bruxelles, Belgium
| | - Elisa Arezes
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Avettand-Fènoël
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
| | - Jean-Joël Bigna
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Stéphane Blanche
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
| | - Cécile Goujard
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Josiane Warszawski
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Paul Viard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
| | - COVERTE
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - PRIMO
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - SEROPRI
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
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12
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Bondarchuk C, Lemon T, Earnshaw V, Rousseau E, Sindelo S, Bekker LG, Butler L, Katz I. Disclosure Events and Psychosocial Well-Being Among Young South African Adults Living with HIV. Int J Behav Med 2024:10.1007/s12529-024-10291-5. [PMID: 38658438 DOI: 10.1007/s12529-024-10291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Poor psychological well-being is both prevalent among South Africans living with HIV and has been associated with poor HIV clinical outcomes. However, the relationship between disclosure and psychological well-being remains unclear. This analysis sought to examine the relationship between two disclosure-related variables, disclosure status and reaction received, and psychosocial well-being among a sample of young adults living with HIV (YALWH) in urban South Africa. METHOD This was a secondary analysis using observational data from Standing Tall, a randomized controlled trial that recruited 100 participants ages 18-24 who tested positive for HIV after initially presenting to two well-established mobile clinics for HIV testing. Interviews investigating primary and secondary outcomes of interest were done at baseline and 6 months following recruitment. RESULTS About half (51%) of participants disclosed their HIV status within 6 months after recruitment. Simple linear regression analyses revealed that disclosure of HIV status within 6 months after study enrollment predicted significantly lower levels of disclosure concerns and internalized stigma (p < 0.05). Reactions to disclosure were not significantly associated with any of the measures of psychosocial well-being considered in this analysis (p > 0.05). CONCLUSION The results suggest that the act of disclosure among newly diagnosed YALWH may be associated with reductions in internalized stigma. In addition, the finding that the act of disclosure may be a more important determinant of psychosocial well-being than the reaction to disclosure has important implications for interventions designed to promote disclosure and psychosocial well-being in YALWH.
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Affiliation(s)
| | - Tiffany Lemon
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - Valerie Earnshaw
- Department of Human Development and Family Services, University of Delaware, Newark, DE, USA
| | - Elzette Rousseau
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Siyaxolisa Sindelo
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Lisa Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Ingrid Katz
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Henderson M, Fidler S, Foster C. Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps. Trop Med Infect Dis 2024; 9:74. [PMID: 38668535 PMCID: PMC11053933 DOI: 10.3390/tropicalmed9040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
In resourced settings, adults living with perinatally acquired HIV are approaching the 5th decade of life. Their clinical and psychological outcomes highlight potential future issues for the much larger number of adolescents growing up with HIV in sub-Saharan Africa, and will inform the development of appropriate healthcare services. Lifelong exposure to HIV, and increasingly to antiretroviral therapy throughout growth and development, contrasts with adults acquiring HIV in later life. This review describes the clinical outcomes for adults living with perinatally acquired HIV including post transition mortality, morbidity and retention in care. Rates of viral suppression, drug resistance and immunological function are explored. Co-morbidities focus on metabolic, cardiovascular, respiratory and bone health with quality-of-life data including neurocognitive functioning and mental health. Sexual and reproductive health including vaccine-preventable disease and the prevention of onward transmission to partners and infants are considered. The data gaps and future research questions to optimise outcomes for this emerging adult cohort are highlighted.
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Affiliation(s)
- Merle Henderson
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Sarah Fidler
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Caroline Foster
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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14
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Ndongo FA, Kana R, Nono MT, Noah JPYA, Ndzie P, Tejiokem MC, Biheng EH, Ndie J, Nkoa TA, Ketchaji A, Ngako JN, Penda CI, Bissek ACZK, Ndombo POK, Hawa HM, Msellati P, Lallemant M, Faye A. Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2024; 72:202193. [PMID: 38523399 DOI: 10.1016/j.jeph.2024.202193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In resource-limited settings, mental health disorders are rarely taken into account in the care offered to HIVIA and have an impact on their routine follow-up. The objective of this study was to assess the baseline socio-demographic factors and mental health conditions associated with detectable viral load or poor ART adherence in HIVIA on ART followed at the Mother and Child Centre of the Chantal Biya Foundation in Yaoundé (CME-FCB), Cameroon. METHODS A cross-sectional study was conducted in HIVIA aged 10 to 19 years, followed at CME-FCB during the period from December 2021 to March 2022. Sociodemographic, clinical, and mental characteristics were collected using a structured questionnaire administered face-to-face by trained healthcare providers. The primary outcome was viral load ≥ 40 copies/mL in HIVIA on ART for at least six months. The secondary outcome was poor ART adherence, defined as ≥ 1 missed dose of antiretroviral therapy within the last past three days. The main exposure variables were mental health disorders, including the level of anxiety, depression and low self-esteem. RESULTS In total, 302 adolescents were interviewed, 159 (52.7 %) were girls and median age was 15.2 years (IQR: 12.0-17.5). Having missed at least 1 dose of ART drugs during the last 3 days before screening concerned 53 (35.0 %) cases. Of the 247 adolescents with an available viral load (VL) in the last 12 months prior to screening, 33 (26.7 %) had a VL ≥ 40 copies/mL. Among participating adolescents, 29.1 % presented with high or very high anxiety, 26.5 % with severe depression, 36.4 % with history of suicidal ideation, and 20.5 % low self-esteem. Low self-esteem was strongly associated with a higher risk of poor ART adherence (adjusted odds ratio(aOR) (95 % confidence interval (95 %CI)): 2.2 (1.1-4.3); p = 0.022). Living with the father (aOR (95 %CI): 0.6 (0.3-1.1); p = 0.085) or in a household with a televisor (aOR (95 %CI): 0.5 (0.2-1.1); p = 0.069) were slightly associated with a lower risk of poor adherence to ART. Having both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) or who were completely disclosed for HIV status (p = 0.070). CONCLUSION This study found that co-morbid low self-esteem had higher odds of poor ART adherence in HIVIA. Moreover, both poor ART adherence, and detectable viral load were associated with impaired life conditions in HIVIA.
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Affiliation(s)
- Francis Ateba Ndongo
- University of Garoua, Cameroon; Centre Mère-enfant, Fondation Chantal Biya, Yaounde, Cameroon; Ministry of Public Health, Yaounde, Cameroun.
| | - Rogacien Kana
- Media Convergence Consulting Office, Yaounde, Cameroon
| | - Marius Tchassep Nono
- Action for Youths and Family, Douala, Cameroon; University of Douala, Douala, Cameroon
| | | | | | | | | | - Justin Ndie
- Ministry of Public Health, Yaounde, Cameroun
| | | | | | | | | | | | | | | | - Philippe Msellati
- Research Institute for Sustainable Development (IRD), Abidjan, Côte d'Ivoire
| | - Marc Lallemant
- Programs for HIV Prevention and Treatment (PHPT) Foundation - Research Institute for Sustainable Development (IRD), Paris, France
| | - Albert Faye
- Hôpital Universitaire Robert Debré, Paris, France
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15
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Gaur AH, Capparelli EV, Calabrese K, Baltrusaitis K, Marzinke MA, McCoig C, Van Solingen-Ristea RM, Mathiba SR, Adeyeye A, Moye JH, Heckman B, Lowenthal ED, Ward S, Milligan R, Samson P, Best BM, Harrington CM, Ford SL, Huang J, Crauwels H, Vandermeulen K, Agwu AL, Smith-Anderson C, Camacho-Gonzalez A, Ounchanum P, Kneebone JL, Townley E, Bolton Moore C. Safety and pharmacokinetics of oral and long-acting injectable cabotegravir or long-acting injectable rilpivirine in virologically suppressed adolescents with HIV (IMPAACT 2017/MOCHA): a phase 1/2, multicentre, open-label, non-comparative, dose-finding study. Lancet HIV 2024; 11:e211-e221. [PMID: 38538160 PMCID: PMC11213970 DOI: 10.1016/s2352-3018(23)00300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Combined intramuscular long-acting cabotegravir and long-acting rilpivirine constitute the first long-acting combination antiretroviral therapy (ART) regimen approved for adults with HIV. The goal of the IMPAACT 2017 study (MOCHA [More Options for Children and Adolescents]) was to assess the safety and pharmacokinetics of these drugs in adolescents. METHODS In this phase 1/2, multicentre, open-label, non-comparative, dose-finding study, virologically suppressed adolescents (aged 12-17 years; weight ≥35 kg; BMI ≤31·5 kg/m2) with HIV-1 on daily oral ART were enrolled at 15 centres in four countries (Botswana, South Africa, Thailand, and the USA). After 4-6 weeks of oral cabotegravir (cohort 1C) or rilpivirine (cohort 1R), participants received intramuscular long-acting cabotegravir or long-acting rilpivirine every 4 weeks or 8 weeks per the adult dosing regimens, while continuing pre-study ART. The primary outcomes were assessments of safety measures, including all adverse events, until week 4 for oral cabotegravir and until week 16 for long-acting cabotegravir and long-acting rilpivirine, and pharmacokinetic measures, including the area under the plasma concentration versus time curve during the dosing interval (AUC0-tau) and drug concentrations, at week 2 for oral dosing of cabotegravir and at week 16 for intramuscular dosing of cabotegravir and rilpivirine. Enrolment into cohort 1C or cohort 1R was based on the participant's pre-study ART, meaning that masking was not done. For pharmacokinetic analyses, blood samples were drawn at weeks 2-4 after oral dosing and weeks 4-16 after intramuscular dosing. Safety outcome measures were summarised using frequencies, percentages, and exact 95% CIs; pharmacokinetic parameters were summarised using descriptive statistics. This trial is registered at ClinicalTrials.gov, NCT03497676, and is closed to enrolment. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled: 30 in cohort 1C and 25 in cohort 1R. At week 16, 28 (97%, 95% CI 82-100) of the 29 dose-evaluable participants in cohort 1C and 21 (91%; 72-99) of the 23 dose-evaluable participants in cohort 1R had reported at least one adverse event, with the most common being injection-site pain (nine [31%] in cohort 1C; nine [39%] in cohort 1R; none were severe). One (4%, 95% CI 0-22) participant in cohort 1R had an adverse event of grade 3 or higher, leading to treatment discontinuation, which was defined as acute rilpivirine-related allergic reaction (self-limiting generalised urticaria) after the first oral dose. No deaths or life-threatening events occurred. In cohort 1C, the week 2 median cabotegravir AUC0-tau was 148·5 (range 37·2-433·1) μg·h/mL. The week 16 median concentrations for the every-4-weeks and every-8-weeks dosing was 3·11 μg/mL (range 1·22-6·19) and 1·15 μg/mL (<0·025-5·29) for cabotegravir and 52·9 ng/mL (31·9-148·0) and 39·1 ng/mL (27·2-81·3) for rilpivirine, respectively. These concentrations were similar to those in adults. INTERPRETATION Study data support using long-acting cabotegravir or long-acting rilpivirine, given every 4 weeks or 8 weeks, per the adult dosing regimens, in virologically suppressed adolescents aged 12 years and older and weighing at least 35 kg. FUNDING The National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark A Marzinke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - John H Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD, USA
| | | | - Elizabeth D Lowenthal
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shawn Ward
- Frontier Science Foundation, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Ellen Townley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama, Birmingham, AL, USA
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16
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Mboggo E, Mtisi E, Mushy SE, Mkawe S, Ngalesoni F, Muya A, Kilimba E, Kamugumya D, Mlay BS. Determinants of viral load suppression failure among HIV adults on ARV attending health care facilities: a retrospective study in Tanga region, Tanzania. BMC Infect Dis 2024; 24:312. [PMID: 38486174 PMCID: PMC10941608 DOI: 10.1186/s12879-023-08604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/12/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Availability and accessibility of Antiretroviral drugs (ARV's) improve the lives of People living with HIV (PLHIV) by improving client's immune system to overcome infections and prevent the development of AIDS and other HIV complications. Combination therapy, early initiation of ART, newer ART drugs, single dosage and drug affordability significantly contribute in the reduction of viral multiplication and suppression of HIV to undetectable plasma levels. METHODS A retrospective longitudinal study design study was conducted from 1st October, 2018 to 30th June 2022 in all supported HIV care and treatment health facilities in Tanga region which were supported by Amref Health Africa, Tanzania. The participants were HIV adult patients aged 15 years and above on ART and attended the clinic at least once after ART initiation. Viral load suppression levels are defined with viral load <1,000 HIV RNA copies/ml (viral load suppression). Cox proportional hazard regression models were employed to identify risk factors for virological failure. P values were two-sided, and we considered a P<0.05 to be statistically significant. RESULTS Fifty-nine thousand five hundred three adult clients >15 years whom were on ART were included in the analysis to determine the level of plasma Viral Load suppression after being on ART. Female 41,304 (69.4%) and male 18,199 (30.6%). Only four percent (2,290) were found to be unsuppressed i.e having plasma Viral Load >1,000cp/ml while 96% (57,213) were virally suppressed. Several factors were independently associated with virologic failure that included; age between 15 - <25 years (HR: 2.82, 95% CI 1.96 - 4.04), BMI <18.5 (HR: 1.69, 95% CI 1.23 - 2.30), advanced WHO stage IV (HR: 1.60, 95% CI 1.12 - 2.24), CD4 cell count <350 (HR: 2.61, 95% CI 2.12 - 3.23), poor adherence (HR: 1.98, 95% CI 1.80 - 2.18) and not using DTG based drug (HR: 11.8, 95% CI 9.74 - 14.3). CONCLUSION Virologic failure was observed in this study among clients with young age, advanced WHO stage IV, not using DTG based regimen, poor drug adherence and second line regime. To improve Viral Load Suppression among these clients; the existing HIV intervention strategies should be taken care by targeting the identified risk factors.
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Affiliation(s)
- Eric Mboggo
- AMREF Health Africa, Dar es Salaam, Tanzania.
| | - Expeditho Mtisi
- Department of General Studies, Dar Es Salaam Institute of Technology, Dar es Salaam, Tanzania
| | - Stella E Mushy
- Department of Community Health Nursing, Muhimbili University of Health Science, Dar es Salaam, Tanzania
| | - Simon Mkawe
- AMREF Health Africa, Dar es Salaam, Tanzania
| | | | - Aisa Muya
- AMREF Health Africa, Dar es Salaam, Tanzania
- Department of Community Health Nursing, Muhimbili University of Health Science, Dar es Salaam, Tanzania
| | | | - Denice Kamugumya
- Center for Disease Control and Prevention, Dar es salaam, Tanzania
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Evangeli M, Foster C, Musiime V, Fidler S, Seeley J, Frize G, Uwizera A, Price J. Cultural Adaption, Translation, Preliminary Reliability and Validity of Key Psychological and Behavioural Measures for 18 to 25 Year-Olds Living with HIV in Uganda: A Multi-Stage Approach. AIDS Behav 2024; 28:924-935. [PMID: 37792229 PMCID: PMC10896775 DOI: 10.1007/s10461-023-04193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
HIV remains a significant public health issue among young adults living in Uganda. There is a need for reliable and valid measures of key psychological and behavioural constructs that are related to important outcomes for this population. We translated, adapted and tested the psychometric properties of questionnaires measuring HIV stigma, HIV disclosure cognitions and affect, antiretroviral therapy (ART) adherence, social support, personal values, and hope, using a multi-step process. This included: translation, back-translation, expert review, cognitive interviewing, readability and assessments of internal consistency with 93 young adults (18-25 years) living with perinatally acquired HIV in Uganda. Preliminary criterion validity was assessed by examining relationships between the adapted measures and wellbeing, HIV disclosure behaviour, HIV disclosure intention and viral load suppression. The measures all showed acceptable reliability and every questionnaire apart from the Agentic and Communal Value Scale was easy to read. Those scales measuring HIV disclosure affect and cognitions, social support, HIV stigma and hope showed relationships with other constructs suggestive of validity. There is preliminary evidence to support the use of these measures in research and clinical contexts for young adults living with perinatally acquired HIV in Uganda.
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Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
| | - Caroline Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - Victor Musiime
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, Imperial College NIHR BRC, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Graham Frize
- Central and North West London NHS Foundation Trust, London, UK
| | - Annette Uwizera
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Joseph Price
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
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18
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Arnold EM, Kamal S, Rotheram-Borus MJ, Bridges SK, Gertsch W, Norwood P, Swendeman D. Factors Associated With Antiretroviral Adherence Among Youth Living With HIV. J Acquir Immune Defic Syndr 2024; 95:215-221. [PMID: 37977178 PMCID: PMC10922292 DOI: 10.1097/qai.0000000000003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Youth living with HIV (YLH) have an increased risk for psychosocial stressors that can affect their antiretroviral (ARV) adherence. We examined factors associated with self-reported ARV adherence among YLH ages 12-24 years old. SETTING YLH (N = 147) were recruited in Los Angeles, CA, and New Orleans, LA from 2017 to 2020. METHODS YLH whose self-reported recent (30 days) ARV adherence was "excellent" or "very good" were compared with nonadherent YLH on sociodemographic, clinical, and psychosocial factors using univariate and multivariate analyses. RESULTS Participants were predominantly male (88%), and 81% identified as gay, bisexual, transgender, queer, or other. The mean duration on ARV was 27 months (range 0-237 months). Most YLH (71.2%) self-reported being adherent, and 79% of those who self-reported adherence were also virally suppressed (<200 copies/mL). Multivariate analysis indicated being adherent was significantly associated with white race [aOR = 8.07, confidence intervals (CI): 1.45 to 74.0], Hispanic/Latinx ethnicity [aOR = 3.57, CI: 1.16 to 12.80], more social support [aOR = 1.11, CI: 1.05 to 1.18], and being on ARV for a shorter duration [aOR = 0.99, CI: 0.97 to 0.99]. Mental health symptoms, substance use, age, and history of homelessness or incarceration were unrelated to adherence. CONCLUSIONS Enhancing efforts to provide support for adherence to non-white youth, and those with limited social support and who have been on ARV treatment longer, may help increase viral suppression among YLH.
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Affiliation(s)
| | - Susan Kamal
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - S Kate Bridges
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX; and
| | - William Gertsch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Peter Norwood
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
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19
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Siril H, Gitagno D, Kaaya S, Caputo M, Hirschhorn L, Nyamuhanga T, Mtei R, Festo C, Hawkins C. Generalized and COVID related anxiety as risk factors for health outcomes among adolescents with HIV during COVID-19 in Tanzania. RESEARCH SQUARE 2024:rs.3.rs-3921926. [PMID: 38410463 PMCID: PMC10896391 DOI: 10.21203/rs.3.rs-3921926/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The COVID-19 pandemic and associated prevention strategies caused widespread interruptions to care and treatment for people living with HIV. Adolescents living with HIV (AWHIV) were particularly vulnerable to poor mental and physical health during COVID-19. We assessed the burden of generalized and COVID-19-related anxiety and associations with adherence to HIV care and treatment and viral load suppression (VLS) among AWHIV during the peak of the COVID-19 pandemic in Tanzania. Methods This cross-sectional study was conducted among AWHIV aged 15-19 years attending 10 clinics in Dar es Salaam from April 2022-February 2023. Study participants completed a self-administered questionnaire including Generalized Anxiety Disorder (GAD), COVID-19-related anxiety, and other psychosocial and physical health and support measures. HIV visit adherence, viral load and sociodemographic data were abstracted from patient health records.Analysis:: Multivariable (MV) quasibinomial and logistic regression models examined associations of Generalized and COVID-19-related anxiety with visit adherence and HIV virologic suppression (HIV VL < 50 copies/mL). Data were analyzed using R software. Results 658 AWHIV (52% male) were included in this analysis. Most (86%) had been on antiretroviral treatment (ART) for at least four years, 55% attended at least 75% of their scheduled clinic visits, and 78% were HIV virologically suppressed. The median GAD and COVID-19-related anxiety scores were 2 (IQR: 0-5, and 26 (IQR: 13-43; respectively. Only 2% scored moderate-severe generalized anxiety (score 10-21). We found no significant associations between COVID-19-related anxiety or GAD and visit adherence. Higher GAD was inversely associated with VLS (adjusted odds ratio (AOR): 0.89 (95% CI 0.81, 0.98)). Female gender and higher quality of physical life were significantly associated with VLS. Conclusion Low levels of generalized and COVID-19 related anxiety were reported among Tanzanian AWHIV. Integrating screening and management of generalized anxiety screening into HIV care for AWHIV could improve VLS among this population.
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Affiliation(s)
- Hellen Siril
- Muhimbili University of Health and Allied Sciences
| | | | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences
| | | | | | | | - Rachel Mtei
- Muhimbili University of Health and Allied Sciences
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20
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White I, Judd A, Castro H, Chappell E. Beliefs about antiretroviral therapy and their association with adherence in young people living with perinatal HIV in England: a cross-sectional analysis. AIDS Care 2024:1-17. [PMID: 38269578 DOI: 10.1080/09540121.2023.2300984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
This cross-sectional analysis aimed to describe beliefs about antiretroviral therapy (ART) in young people living with perinatal HIV (PHIV) in England, and the association between these beliefs and adherence to ART. The Beliefs About Medicine Questionnaire (Highly Active Antiretroviral Therapy version), was used to measure participants' beliefs in the necessity of ("Necessity score") and concerns regarding ("Concerns score") ART. Participants were classified as having high/low total scores using midpoints of the score scales. Associations between beliefs and being Last Month Adherent (LMA; self-reported not missing more than 2 consecutive ART doses in the month prior to the interview) were analysed using logistic regression, adjusting for sociodemographic, clinical, and psychosocial variables. Of 247 PHIV (median age = 18.6 years), 158 (64%) were LMA. 224 (91%) had a high Necessity score and 54 (22%) a high Concerns score. There was no association between high Necessity score and LMA in multivariable analysis (adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI) = 0.34-5.28, p = 0.679); however, high Concerns score was independently associated with a reduced odds of being LMA (aOR = 0.19, CI = 0.07-0.47, p < 0.001). Interventions to address the concerns young people living with PHIV have about ART should be explored as a strategy to improve their adherence.
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Affiliation(s)
- Iona White
- MRC Clinical Trials Unit at UCL, UCL, London, UK
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, UCL, London, UK
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21
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Kose J, Howard T, Lenz C, Masaba R, Akuno J, Woelk G, Fraaij PL, Rakhmanina N. Experiences of adolescents and youth with HIV testing and linkage to care through the Red Carpet Program (RCP) in Kenya. PLoS One 2024; 19:e0296786. [PMID: 38241210 PMCID: PMC10798534 DOI: 10.1371/journal.pone.0296786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/19/2023] [Indexed: 01/21/2024] Open
Abstract
Adolescents and youth living with HIV (AYLHIV) experience worse health outcomes compared to adults. We aimed to understand the experiences of AYLHIV in care in the youth-focused Red-Carpet program in Kenya to assess the quality of service provision and identify programmatic areas for optimization. We conducted focus group discussions among 39 AYLHIV (15-24 years) and structured analysis into four thematic areas. Within the HIV testing theme, participants cited fear of positive results, confidentiality and stigma concerns, and suggested engaging the community and youth in HIV testing opportunities. Within the HIV treatment adherence theme, participants cited forgetfulness, stigma, adverse side effects, lack of family support, and treatment illiteracy as barriers to adherence. Most participants reported positive experiences with healthcare providers and peer support. In terms of the HIV status disclosure theme, AYLHIV cited concerns about their future capacity to conceive children and start families and discussed challenges with understanding HIV health implications and sharing their status with friends and partners. Youth voices informing service implementation are essential in strengthening our capacity to optimize the support for AYLHIV within the community, at schools and healthcare facilities.
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Affiliation(s)
- Judith Kose
- Africa Centres for Disease Control and Prevention (Africa CDC), Nairobi, Kenya
- Erasmus MC, Department of Viroscience, Erasmus University, Rotterdam, the Netherlands
| | - Tyriesa Howard
- Brown School at Washington University in St. Louis, St. Louis, MO, United States of America
| | - Cosima Lenz
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Rose Masaba
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Job Akuno
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Godfrey Woelk
- Research Department, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Pieter Leendert Fraaij
- Pediatric Infectious Diseases Division, Erasmus MC-Sophia/ Erasmus University, Rotterdam, the Netherlands
| | - Natella Rakhmanina
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- The George Washington University, Washington, DC, United States of America
- Children’s National Hospital, Washington, DC, United States of America
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22
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Bokharaei-Salim F, Khanaliha K, Monavari SH, Kiani SJ, Tavakoli A, Jafari E, Chavoshpour S, Razizadeh MH, Kalantari S. Human Immunodeficiency Virus-1 Drug Resistance Mutations in Iranian Treatment-experienced Individuals. Curr HIV Res 2024; 22:53-64. [PMID: 38310469 DOI: 10.2174/011570162x273321240105081444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Human immunodeficiency virus-1 infection still remains a global health threat. While antiretroviral therapy is the primary treatment option, concerns about the emergence of drug-resistance mutations and treatment failure in HIV-infected patients persist. OBJECTIVE In this study, we investigated the development of drug resistance in HIV-1-infected individuals receiving antiretroviral therapy for 6-10 years. METHODS In this cross-sectional study, we evaluated 144 people living with HIV-1 who had received antiretroviral therapy for at least 6 years. Plasma specimens were collected, and the HIV-1 viral load and drug-resistance mutations were assessed using molecular techniques. RESULTS The demographic and epidemiological characteristics of the participants were also analyzed: Twelve [8.3%) of the studied patients showed a viral load over 1000 copies per/mL, which indicates the suboptimal response to antiretroviral therapy. Significant correlations were found between viral load and CD4 count, as well as epidemiological factors, such as vertical transmission, history of imprisonment, and needle stick injuries. Drug resistance mutations were detected in 10 (83.3%) of patients who failed on antiretroviral therapy, with the most common mutations observed against nucleoside reverse transcriptase inhibitors (5 (41.7%)) and non-nucleoside reverse transcriptase inhibitors (9 (75%)). Phylogenetic analysis revealed that 12 patients who failed treatment were infected with CRF35_AD. CONCLUSION Our study provides important insights into the characteristics and development of drug resistance in HIV-1-infected individuals receiving long-term antiretroviral therapy in Iran. The findings underline the need for regular viral load monitoring, individualized treatment selection, and targeted interventions to optimize treatment outcomes and prevent the further spread of drug-resistant strains.
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Affiliation(s)
- Farah Bokharaei-Salim
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Khanaliha
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Jalal Kiani
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Ensieh Jafari
- Department of Biology, Faculty of Basic Sciences, Noor Danesh University, Isfahan, Iran
| | - Sara Chavoshpour
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Kalantari
- Departments of Infectious Diseases and Tropical Medicine, Iran University of Medical Sciences, Tehran, Iran
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Musanje K, Kamya MR, Kasujja R, Vanderplasschen W, Sinclair DL, Baluku MM, Odokonyero RF, Namisi CP, Mukisa J, White RG, Camlin CS. The Effect of a Group-Based Mindfulness and Acceptance Training on Psychological Flexibility and Adherence to Antiretroviral Therapy Among Adolescents in Uganda: An Open-Label Randomized Trial. J Int Assoc Provid AIDS Care 2024; 23:23259582241236260. [PMID: 38446992 PMCID: PMC10919136 DOI: 10.1177/23259582241236260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15-19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15-19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, P = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, P = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | | | | | - Martin M. Baluku
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | | | - Charles P. Namisi
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
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24
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Zurbachew Y, Hiko D, Bacha G, Merga H. Adolescent's and youth's adherence to antiretroviral therapy for better treatment outcome and its determinants: multi-center study in public health facilities. AIDS Res Ther 2023; 20:91. [PMID: 38115098 PMCID: PMC10729566 DOI: 10.1186/s12981-023-00588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Low-adherence to Anti-retroviral therapy (ART) negatively affects the clinical, immunological, and virologic outcomes of patients. Adherence is the most important factor in determining Antiretroviral Therapy (ART) treatment success and long-term viral suppression which ultimately reduces morbidity and mortality. Thus, this study aimed to identify factors affecting adherence to antiretroviral therapy among adolescents and youth living with HIV. METHODS Facility-based cross-sectional study was conducted from March 21 to April 30, 2020 among 316 respondents in selected five high-loaded hospitals with adolescent and youth clients using systematic random sampling technique. Patients' adherence was assessed when they had reportedly taken 95% or higher of their prescribed antiretroviral drugs in the five days before the interview. Data were collected, entered into EPI Data and exported to SPSS for analysis. Binary logistic regression was used to see the association between dependent and independent variables. RESULTS In this study, 316 respondents participated in the study, with a 99.7% response rate. The mean age of respondents were 17.94 years and majority of them (58.5%) were females. The overall ART adherence among adolescents and youths was found to be 70.6%. Being female (AOR = 0.323, 95% CI, 0.164-0.637), presence of opportunistic infection (AOR = 0.483, 95% CI, 0.249-0.936), taking additional medication beside ART (AOR = 0.436, 95% CI, 0.206-0.922) and availability of youth friendly services within the facility (AOR = 2.206, 95% CI, 1.031-4.721) were found to be predictors. CONCLUSION The adherence rate in this study was low which is below the recommended adherence level. Being female, taking additional medication beside ART and presence of opportunistic infection were determinants of adherence. As a result, significant work must be done on opportunistic infection prevention through health education and promotion for screening and risk reduction. Similarly, adolescents and youths service integration with the ART Clinic is strongly advised.
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Affiliation(s)
| | - Desta Hiko
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Girma Bacha
- Department of Nursing, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Hailu Merga
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia.
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25
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Tendongfor N, Fokam J, Chenwi CA, Nwabo FLT, Nangmo A, Debimeh N, Moyo STN, Halle MP, Njom-Nlend AE, Ndombo PK, Ndjolo A. Determinants of survival of adolescents receiving antiretroviral therapy in the Centre Region of Cameroon: a multi-centered cohort-analysis. AIDS Res Ther 2023; 20:88. [PMID: 38098059 PMCID: PMC10722663 DOI: 10.1186/s12981-023-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND In spite of the global decreasing mortality associated with HIV, adolescents living with HIV (ADLHIV) in sub-Saharan Africa still experience about 50% mortality rate. We sought to evaluate survival rates and determinants of mortality amongst ADLHIV receiving antiretroviral therapy (ART) in urban and rural settings. METHODS A multi-centered, 10-year retrospective, cohort-study including ADLHIV on ART ≥ 6 months in the urban and rural settings of the Centre Region of Cameroon. Socio-demographic, clinical, biological, and therapeutic data were collected from files of ADLHIV. The Kaplan-Meier method was used to estimate survival probability after ART initiation; the log rank test used to compare survival curves between groups of variables; and the Cox proportional hazard model was used to identify the determinants of mortality. RESULTS A total of 403 adolescents' records were retained; 340 (84%) were from the urban and 63 (16%) from the rural settings. The female to male ratio was 7:5; mean age (Standard deviation) was 14.1 (2.6) years; at baseline, 64.4% were at WHO clinical stages I/II, 34.9% had ≥ 500 CD4 cells/mm3, 91.1% were anemic, and the median [Inter Quartile Range] duration on ART was5.3 [0.5-16] years. The survival rate at 1, 5 and 10 years on ART was respectively 97.0%, 55.9% and 8.7%; with mean survival time of 5.8 years (95% CI 5.5-6.1). In bivariate analysis, living in the rural setting, non-disclosed HIV status, baseline CD4 count < 500 cells/mm3, not being exposed to nevirapine prophylaxis at birth and being horizontally infected were found to be the determinants of higher mortality with poor retention in care slightly associated with mortality. In multivariate analysis, living in rural settings, poor retention in care and anemia were independent predictors of mortality (p < 0.05). CONCLUSION Although ADLHIV have good survival rate on ART after 1 year, we observe poor survival rates after 5 years and especially 10 years of treatment experience. Mitigating measures against poor survival should target those living in rural settings, anemic at baseline, or experiencing poor retention in care.
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Affiliation(s)
| | - Joseph Fokam
- Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Collins Ambe Chenwi
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Fabrice Léo Tamhouo Nwabo
- Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
| | - Armanda Nangmo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
| | - Njume Debimeh
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Marie Patrice Halle
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Science, University of Douala, Douala, Cameroon
| | - Anne-Esther Njom-Nlend
- Pediatric Department, National Social Welfare Centre, Essos Health Centre, Yaoundé, Cameroon
- Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
| | - Paul Koki Ndombo
- Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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26
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Ronen K, Mugo C, Kaggiah A, Seeh D, Kumar M, Guthrie BL, Moreno MA, John-Stewart G, Inwani I. Facilitated WhatsApp Support Groups for Youth Living With HIV in Nairobi, Kenya: Single-Arm Pilot Intervention Study. JMIR Form Res 2023; 7:e49174. [PMID: 37955957 PMCID: PMC10682925 DOI: 10.2196/49174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Mobile technology can support HIV care, but studies in youth are limited. In 2014, youth receiving HIV care at several health care facilities in Nairobi, Kenya spontaneously formed peer support groups using the social media platform WhatsApp. OBJECTIVE Inspired by youth-initiated groups, we aimed to evaluate the use of WhatsApp to deliver a social support intervention to improve HIV treatment and psychosocial outcomes in youth. We developed a facilitated WhatsApp group intervention (named Vijana-SMART), which was grounded in social support theory and guided by the design recommendations of youth living with HIV. This paper evaluates the intervention's acceptability and pre-post changes in health outcomes. METHODS The intervention involved interactive WhatsApp groups facilitated by study staff for 6 months, with each group having approximately 25 members. Study staff sent weekly structured messages, and the message content was based on social support theory and encouraged unstructured peer-to-peer messaging and support. We conducted a single-arm pilot among 55 youth living with HIV aged 14-24 years recruited from a government health care facility serving a mixed-income area of Nairobi. At enrollment and follow-up, self-report questionnaires assessed acceptability; antiretroviral therapy (ART) information, motivation, and behavioral skills (IMB); depression; social support; stigma; resilience; and ART adherence. All participants received the intervention. We used generalized estimating equations (GEEs) clustered by participant to evaluate changes in scores from baseline to follow-up, and correlates of participant WhatsApp messaging. RESULTS The median participant age was 18 years, and 67% (37/55) were female. Intervention acceptability was high. All participants reported that it was helpful, and 73% (38/52) sent ≥1 WhatsApp message. Messaging levels varied considerably between participants and were higher during school holidays, earlier in the intervention period, and among youth aged ≥18 years. IMB scores increased from enrollment to follow-up (66.9% to 71.3%; P<.001). Stigma scores also increased (8.3% to 16.7%; P=.001), and resilience scores decreased (75.0% to 70.0%; P<.001). We found no significant change in ART adherence, social support, or depression. We detected a positive association between the level of messaging during the study and the resilience score, but no significant association between messaging and other outcomes. Once enrolled, it was common for participants to change their phone numbers or leave the groups and request to be added back, which may present implementation challenges at a larger scale. CONCLUSIONS Increased IMB scores following WhatsApp group participation may improve HIV outcomes. Increased stigma and decreased resilience were unintended consequences and may reflect transient effects of group sharing of challenging experiences, which should be addressed in larger randomized evaluations. WhatsApp groups present a promising and acceptable modality to deliver supportive interventions to youth living with HIV beyond the clinic, and further evaluation is warranted. TRIAL REGISTRATION ClinicalTrials.gov (NCT05634265); https://clinicaltrials.gov/study/NCT05634265.
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Affiliation(s)
- Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Cyrus Mugo
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Anne Kaggiah
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - David Seeh
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- New York University Langone Health, New York, NY, United States
| | - Brandon L Guthrie
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin - Madison, Madison, WI, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Irene Inwani
- Department of Pediatrics, Kenyatta National Hospital, Nairobi, Kenya
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Zhou S, Toska E, Langwenya N, Edun O, Cluver L, Knight L. Exploring Self-reported Adherence Measures to Screen for Elevated HIV Viral Load in Adolescents: A South African Cohort Study. AIDS Behav 2023; 27:3537-3547. [PMID: 37067612 PMCID: PMC10589188 DOI: 10.1007/s10461-023-04068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
The timely identification of ART non-adherence among adolescents living with HIV presents a significant challenge, particularly in resource-limited settings where virologic monitoring is suboptimal. Using South African adolescent cohort data (N = 933, mean age 13.6 ± 2.89 years, 55.1% female, follow-up = 2014-2018), we examined the association between elevated viral load (VL ≥ 1000 copies/mL) and seven self-reported adherence measures on missed doses, and clinic appointments -with varying recall timeframes. The best performing measures, which were significantly associated with elevated viral load in covariate-adjusted models are: any missed dose -past 3 days (sensitivity = 91.6% [95%CI: 90.3-92.8], positive predictive value (PPV) = 78.8% [95%CI: 77.2-80.4]), -past week (sensitivity = 87% [95%CI: 85.4-88.6], PPV = 78.2% [95%CI: 76.5-79.9]), -past month (sensitivity = 79.5% [95%CI: 77.5-81.4], PPV = 78.2% [95%CI: 76.4-79.9]), any past-month days missed (sensitivity = 86.7% [95%CI: 85.1-88.3], PPV = 77.9% [95%CI:76.2-79.6]), and any missed clinic appointment (sensitivity = 88.3% [95%CI: 86.8-89.8], PPV = 78.4% [95%CI: 76.8-79.9]). Combining the three best performing measures missed dose -past 3 days, -past week, and any past-year missed clinic appointment increased sensitivity to 96.4% while maintaining a PPV of about 78%. The discriminatory power of simple and easy-to-administer self-reported adherence measures in detecting elevated viral load warrants consideration in resource-limited settings and may contribute to the aims of the new Global Alliance to End AIDS in children and adolescents by 2030.
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Affiliation(s)
- Siyanai Zhou
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa.
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Olanrewaju Edun
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Boadu I, Manu A, Aryeetey RNO, Kesse KA, Abdulai M, Acheampong E, Akparibo R. Adherence to antiretroviral therapy among HIV patients in Ghana: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002448. [PMID: 37910452 PMCID: PMC10619784 DOI: 10.1371/journal.pgph.0002448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 11/03/2023]
Abstract
Maintaining a high level of adherence to antiretroviral therapy (ART) is critical to limiting rapid viral replication, drug resistance, and viral transmission. However, ART adherence remains a major challenge in HIV/AIDS treatment success. This systematic review and meta-analysis was aimed to synthesize available evidence on adherence to ART among HIV/AIDS patients in Ghana.This review followed the preferred reporting item for systematic review and meta-analysis (PRISMA) criteria. A comprehensive literature search was done using five online databases (PubMed, Google Scholar, Medline, Africa Index Medicus, and Willey Online Library) from 25th- 30th April 2023 to identify potential studies. In addition, references of related articles were manually searched to further identify relevant studies. Search records were managed in Endnote library where duplicates were removed prior to screening. Studies were eligible for inclusion if they were conducted in Ghana, designed as an observational or experimental study, and explicitly measured adherence to ART, either as a primary or secondary outcome. Studies were excluded if the proportion or prevalence of adherence to ART was not reported.A total number of 126 potential studies were identified from the literature search. Of these, 14 met the inclusion criteria and were included in the Meta-analysis. The studies involved a total number of 4,436 participants. The pooled estimate of adherence to ART was 70% (CI: 58-81%). In subgroup analysis, adolescents and young adults had a lower adherence rate (66%, CI: 46-84%) compared with adults (70%; CI: 58-81%). Publication bias was not observed among studies. The pooled estimate of optimal adherence to ART among HIV patients in Ghana was lower than is recommended (≥95%) to achieve viral suppression. Adherence was lower among young persons living with HIV/AIDS. To achieve the United Nation's Sustainable development goals and the UNAIDS "95-95-95" targets, there is a need to focus on improving adherence interventions among persons living with HIV/AIDS, especially among the younger cohort.
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Affiliation(s)
- Isaac Boadu
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Adom Manu
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Richmond Nii Okai Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Kwame Adjei Kesse
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Marijanatu Abdulai
- Department of Epidemiology and Disease Control, School of Public Health, Legon, University of Ghana, Accra, Ghana
- Ghana National AIDS/STI Control Programme (NACP), Accra, Ghana
| | - Emmanuel Acheampong
- Institute of Precision Health, University of Leicester, Leicester, United Kingdom
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
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Saberi P, Stoner MCD, McCuistian CL, Balaban C, Ming K, Wagner D, Chakraborty B, Smith L, Sukhija-Cohen A, Neilands TB, Gruber VA, Johnson MO. iVY: protocol for a randomised clinical trial to test the effect of a technology-based intervention to improve virological suppression among young adults with HIV in the USA. BMJ Open 2023; 13:e077676. [PMID: 37802624 PMCID: PMC10565330 DOI: 10.1136/bmjopen-2023-077676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Young adults with HIV (YWH) experience worse clinical outcomes than adults and have high rates of substance use (SU) and mental illness that impact their engagement in care and adherence to antiretroviral therapy (ART). The intervention for Virologic Suppression in Youth (iVY) aims to address treatment engagement/adherence, mental health (MH) and SU in a tailored manner using a differentiated care approach that is youth friendly. Findings will provide information about the impact of iVY on HIV virological suppression, MH and SU among YWH who are disproportionately impacted by HIV and at elevated risk for poor health outcomes. METHODS AND ANALYSIS The iVY study will test the effect of a technology-based intervention with differing levels of resource requirements (ie, financial and personnel time) in a randomised clinical trial with an adaptive treatment strategy among 200 YWH (18-29 years old). The primary outcome is HIV virological suppression measured via dried blood spot. This piloted and protocolised intervention combines: (1) brief weekly sessions with a counsellor via a video-chat platform (video-counselling) to discuss MH, SU, HIV care engagement/adherence and other barriers to care; and (2) a mobile health app to address barriers such as ART forgetfulness, and social isolation. iVY has the potential to address important, distinct and changing barriers to HIV care engagement (eg, MH, SU) to increase virological suppression among YWH at elevated risk for poor health outcomes. ETHICS AND DISSEMINATION This study and its protocols have been approved by the University of California, San Francisco Institutional Review Board. Study staff will work with a Youth Advisory Panel to disseminate results to YWH, participants and the academic community. TRIAL REGISTRATION NUMBER NCT05877729.
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Affiliation(s)
- Parya Saberi
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Caravella L McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Celeste Balaban
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Kristin Ming
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Bibhas Chakraborty
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, NC, USA
- Centre for Quantitative Medicine and Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Louis Smith
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | | | - Torsten B Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Valerie A Gruber
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
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Harrison A, Mtukushe B, Kuo C, Wilson-Barthes M, Davidson B, Sher R, Galárraga O, Hoare J. Better Together: acceptability, feasibility and preliminary impact of chronic illness peer support groups for South African adolescents and young adults. J Int AIDS Soc 2023; 26 Suppl 4:e26148. [PMID: 37909178 PMCID: PMC10618872 DOI: 10.1002/jia2.26148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/14/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Peer support can help navigate the isolation and psychological strain frequently experienced by youth living with chronic illness. Yet, data are lacking on the impact of providing support for youth living with mixed chronic conditions. We assessed the acceptability, feasibility and preliminary mental health impacts of a clinic-based peer support group for South African youth living with chronic illnesses, including HIV. METHODS This mixed-methods pilot study (September 2021-June 2022) enrolled 58 young patients, ages 13-24, at an urban hospital in Cape Town, South Africa. In-depth interviews elicited the perspectives of 20 young people in relation to their participation in the Better Together programme, a recurring clinic-based peer support group for patients with mixed chronic illnesses. Self-reported resilience, attitudes towards illness, stigma and mental health were captured via established measures. T-tests and multivariate analysis of variance compared psychosocial outcomes for 20 group participants and 38 control patients, controlling for socio-demographic characteristics at enrolment. Logistic regression analyses estimated the predicted probability of a positive depression or anxiety screening given peer group participation. RESULTS All interviewees valued being able to compare treatment regimens and disease management habits with peers living with different conditions. Adolescents living with HIV stated that understanding the hardships faced by those with other conditions helped them accept their own illness and lessened feelings of isolation. Compared to patients who did not participate in Better Together, those who attended ≥5 groups had statistically significantly higher individual-level resilience, a more positive attitude towards their illness(es), lower internalised stigma and a more positive self-concept. The probability of being screened positive for depression was 23.4 percentage points lower (95% CI: 1.5, 45.3) for Better Together participants compared to controls; the probability of a positive anxiety screening was 45.8 percentage points lower (95% CI: 18.1, 73.6). CONCLUSIONS Recurring, clinic-based peer support groups that integrate youth living with HIV and other chronic diseases are novel. Group sustainability will depend on the commitment of experienced peer leaders and providers, routine scheduling and transportation support. A fully powered randomised trial is needed to test the optimal implementation and causal mental health effects of the Better Together model.
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Affiliation(s)
- Abigail Harrison
- International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bulelwa Mtukushe
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Caroline Kuo
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Health Studies, American University, Washington, DC, USA
| | - Marta Wilson-Barthes
- International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Bianca Davidson
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Rebecca Sher
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Omar Galárraga
- International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jacqueline Hoare
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Dufour I, Fougère Y, Goetghebuer T, Hainaut M, Mbiya B, Kakkar F, Yombi JC, Van der Linden D. Gen Z and HIV-Strategies for Optimizing the Care of the Next Generation of Adolescents Living with HIV. Viruses 2023; 15:2023. [PMID: 37896800 PMCID: PMC10611287 DOI: 10.3390/v15102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The management of adolescents living with HIV represents a particular challenge in the global response to HIV. The challenges specific to this age group include difficulties engaging and maintaining them in care, challenges with transition to adult care, and limited therapeutic options for treatment-experienced patients, all of which have been jeopardized by the COVID-19 pandemic. This paper summarizes some of the challenges in managing adolescents living with HIV, as well as some of the most recent and innovative therapeutic approaches in this population.
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Affiliation(s)
- Inès Dufour
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
| | - Yves Fougère
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Marc Hainaut
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Benoît Mbiya
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo;
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
| | - Dimitri Van der Linden
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
- Pediatric Infectious Diseases, Service of Specialized Pediatrics, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
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Chakakala-Chaziya J, Patson N, Samuel V, Mbotwa J, Buonsenso D, Chisale M, Phiri E, O’Hare B. A comparison of clinical outcomes among people living with HIV of different age groups attending queen Elizabeth central hospital outpatient ART Clinic in Malawi. Front Med (Lausanne) 2023; 10:1175553. [PMID: 37795414 PMCID: PMC10546013 DOI: 10.3389/fmed.2023.1175553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Adherence to Antiretroviral Treatment (ART) in children and adolescents living with HIV in low-resource settings is not extensively studied in large cohort studies including both adults and pediatric patients. We compared rates of virological suppression, adherence and defaulting among children, adolescents and adults attending a family ART clinic at Queen Elizabeth Central Hospital; a tertiary hospital situated in the southern region of Malawi. Methods The study was longitudinal and made use of routinely collected data for all 27,229 clinic attendees. Clinical information obtained at routine clinical visits entered electronically since 2008 was extracted in February 2017. This data was used to ascertain differences across the different age groups. Logistic regression and Cox regression models were fitted to compare rates of Virological Suppression (VS), adherence, and defaulting, respectively. Results Younger and older adolescents (ages 10-14 years and 15-19 years respectively) were less likely to achieve VS compared to adults in the final model AOR 0.4 (0.2-0.9, 95% CI) and AOR 0.2 (0.1-0.4, 95% CI) respectively. Young children (ages 0-4 years), older children (ages 5-9 years) and younger adolescents were less adherent to ART compared to adults AOR 0.1 (0.1-0.2, 95% CI), AOR 0.2 (0.1-0.3, 95% CI), and AOR 0.4 (0.3-0.5, 95% CI) respectively. Young adults and younger children had an increased likelihood of defaulting compared to adults. Conclusion Poor performance on ART of children and adolescents highlights unaddressed challenges to adherence. Ongoing research to explore these potential barriers and possible interventions needs to be carried out. The adherence assessment methods used and strategies for improving it among children and adolescents need to be revised at the clinic.
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Affiliation(s)
- Jessica Chakakala-Chaziya
- Department of Paediatrics and Child Health, Mzuzu Central Hospital, Ministry of Health, Lilongwe, Malawi
| | - Noel Patson
- The School of Public Health, University of Witswaterands, Johannesburg, South Africa
| | - Vincent Samuel
- The School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi
- Malawi Liverpool Wellcome Trust Research Programme, Blantyre, Malawi
| | - John Mbotwa
- Malawi Liverpool Wellcome Trust Research Programme, Blantyre, Malawi
- The Department of Applied Studies, Division of Statistics, Malawi University of Science and Technology, Mikolongwe, Malawi
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Master Chisale
- Faculty of Science Technology and Innovations, Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - Eddie Phiri
- The Umodzi Family ART Clinic, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bernadette O’Hare
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Zomba, Malawi
- The Division of Infection and Global Health, University of St Andrews, St Andrews, United Kingdom
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Byansi W, Nabunya P, Muwanga J, Mwebembezi A, Damulira C, Mukasa B, Zmachinski L, Nattabi J, Brathwaite R, Namuwonge F, Bahar OS, Neilands TB, Mellins CA, Ssewamala FM. The relationship between life satisfaction, personal health, quality of life, and medication adherence among adolescents living with HIV in southwestern Uganda. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023; 31:1177-1184. [PMID: 37576468 PMCID: PMC10414752 DOI: 10.1007/s10389-021-01632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 06/16/2021] [Indexed: 11/26/2022]
Abstract
Purpose Adolescents living with HIV (ALHIV) are at high risk for adherence to antiretroviral (ART) treatment and poor health-seeking behaviors, both of which potentially compromise their quality of and satisfaction with life. This study, therefore, seeks to examine the relationship between physical health, pediatric quality of life, life satisfaction, and medication adherence among ALHIV in southwestern Uganda. Methods Baseline data from the Suubi+Adherence study, 2012-2018, that recruited 702 adolescents, aged 10-16 years, living with HIV in Uganda were analyzed. To account for overdispersion, negative binomial regression analyses were used to examine the impact of physical health, pediatric quality of life, and life satisfaction on self-reported medication adherence. We controlled for participants' socio-demographic factors. Results Results indicated that after adjusting for socio-demographic characteristics, adolescents' reported satisfaction with life was associated with a decrease in the reported number of days missed taking medication by 41.2% (IRR (incidence risk ratio)=0.588; p (p-value)=0.014). On the other hand, the low level of pediatric quality of life was associated with a 5% increase in the reported number of days missed taking medication (IRR=1.055, p=0.044). Personal health was not statistically significant in the model. Conclusion Our study findings indicated that quality of life and life satisfaction are significantly associated with antiretroviral (ART) medication among ALHIV. Hence, strengthening existing support systems and creating additional support for optimal ART adherence and treatment outcomes for ALHIV in low-resource communities might be beneficial. Moreover, with the increasing HIV prevalence rates among adolescents, effective and comprehensive efforts that are responsive to the special needs of ALHIV must be developed to ensure optimal adherence to ART medication as it leads to low vertical infection and superinfection rates.
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Affiliation(s)
- William Byansi
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Joelynn Muwanga
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | | | - Christopher Damulira
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
| | | | - Lily Zmachinski
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Jennifer Nattabi
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
| | - Rachel Brathwaite
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Flavia Namuwonge
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Torsten B. Neilands
- School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Claude A. Mellins
- Columbia University Medical Center, 630 West 168th Street New York, NY 10032, United States
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
- Reach the Youth Uganda
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Kanagasabai U, Aholou T, Chevalier MS, Tobias JL, Okuku J, Shiraishi RW, Sheneberger R, Pande YC, Chifuwe C, Mamane LE, Njika G, Obongo C, Thorsen VC. Reaching Youth Through Faith Leaders: Evaluation of the Faith Matters! Initiative. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:82-99. [PMID: 37406142 PMCID: PMC11075127 DOI: 10.1521/aeap.2023.35.suppa.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Faith leaders can be uniquely positioned to guide and support young people on health issues, particularly HIV/AIDS and sexual violence. Faith Matters!, a 2-day training workshop for faith leaders, was delivered in September 2021 in Zambia. Sixty-six faith leaders completed a questionnaire at baseline, 64 at posttraining, and 59 at 3-month follow-up. Participants' knowledge, beliefs, and comfort communicating about HIV/AIDS and sexual violence were assessed. More faith leaders accurately identified common places where sexual violence occurs at the 3-month point compared to baseline: at church (2 vs. 22, p = .000), the fields (16 vs. 29, p = .004), parties (22 vs. 36, p = .001), and clubs (24 vs. 35, p = .034). More faith leaders stated that they engaged in conversations that supported people living with HIV (48 at baseline vs. 53, p = .049 at 3-month follow-up). These findings can inform future HIV/AIDS initiatives focusing on increasing the capacity among communities of faith.
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Affiliation(s)
- Udhayashankar Kanagasabai
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Tiffiany Aholou
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Michelle S Chevalier
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - James L Tobias
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jackson Okuku
- Division of Global HIV & TB, CGH, CDC, Lusaka, Zambia
| | - Ray W Shiraishi
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | | | - Clifton Chifuwe
- Executive Director and Global Master Trainer at the Centre for Peace Research and Advocacy, Zambia
| | - Lauren Erickson Mamane
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Office of the Director, CGH, CDC, Atlanta, Georgia
| | | | - Chris Obongo
- Regional Measurement Specialist and Global Master Trainer at PATH, Kenya
| | - Viva C Thorsen
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Toska E, Zhou S, Chen-Charles J, Gittings L, Operario D, Cluver L. Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa. AIDS Behav 2023; 27:2163-2175. [PMID: 36622486 PMCID: PMC9827015 DOI: 10.1007/s10461-022-03949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
Long-acting injectable anti-retroviral therapy (LAART) may overcome barriers to long-term adherence and improve the survival of adolescents and young people living with HIV (AYLHIV). Research on the acceptability of LAART for this age-group is limited. We asked 953 AYLHIV about their preferred (theoretical) ART mode of delivery (pill, injectable, or other) in 2017-2018, before LAART was available or known to AYLHIV in South Africa. One in eight (12%) AYLHIV preferred LAART over single or multiple pill regimens. In multivariate analyses, six factors were associated with LAART preference: medication stock-outs (aOR = 2.56, 95% CI 1.40-4.68, p = 0.002), experiencing side-effects (aOR = 1.84, 95% CI 1.15-2.97, p = 0.012), pill-burden (aOR = 1.88, 95% CI 1.20-2.94, p = 0.006), past-year treatment changes (aOR = 1.63, 95% CI 1.06-2.51, p = 0.025), any HIV stigma (aOR = 2.22, 95% CI 1.39-3.53, p ≤ 0.001) and recent ART initiation (aOR = 2.02, 95% CI 1.09-3.74, p = 0.025). In marginal effects modelling, 66% of adolescents who experienced all factors were likely to prefer LAART, highlighting the potential high acceptability of LAART among adolescents and young people living with HIV struggling to adhere and have good HIV treatment outcomes. Adolescent boys who reported high ART pill burden were more likely to prefer LAART than their female peers in moderation analyses, suggesting that LAART may be particularly important to improve treatment outcomes among male AYLHIV as they become older. Adding LAART to existing treatment options for AYLHIV, particularly higher risk groups, would support AYLHIV to attain and sustain viral suppression-the third 95, and reduce their risk of AIDS-related mortality.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
- Centre for Social Science Research, Leslie Social Sciences Building, University of Cape Town, 4.89, Rondebosch, Cape Town, 7700, South Africa.
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen-Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lesley Gittings
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, UK
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Singtoroj T, Teeraananchai S, Chokephaibulkit K, Phanuphak N, Gatechompol S, Hansudewechakul R, Dang HLD, Tran DNH, Kerr S, Sohn AH. Factors Associated with Morbidity and Mortality Among Sexually Active Asian Adolescents and Young Adults with Perinatally Acquired HIV. AIDS Res Hum Retroviruses 2023; 39:285-293. [PMID: 36515173 PMCID: PMC10278009 DOI: 10.1089/aid.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We assessed morbidity and mortality among Thai and Vietnamese adolescents and young adults with perinatally acquired human immunodeficiency virus (PHIV) compared with matched HIV-negative peers, 12-24 years of age. Data on serious adverse events (SAEs) were prospectively collected between 2013 and 2018 according to U.S. NIH Division of AIDS criteria. Of 288 youth, 142 had PHIV and 146 were HIV negative. At enrollment, the overall median age was 19 (interquartile range [IQR] 17-20) years, 67% were female, and 95% were Thai. Almost all PHIV youth (99%) were receiving antiretroviral therapy; 50% self-reported adherence ≥95%. Median CD4 was 579 (IQR 404-800) cells/mm3, and 24% had HIV-RNA ≥1,000 copies/mL. During follow-up, 31 (22%) PHIV youth and 9 (6%) HIV-negative youth had at least one SAE. The overall crude SAE rate was 4.66 (3.42-6.35) per 100 person-years (PY); 7.22 (5.08-10.26) per 100 PY among youth with PHIV and 2.10 (1.09-4.03) per 100 PY in HIV-negative youth (p < .001). All seven deaths that occurred were among those with PHIV and primarily due to opportunistic infections (e.g., pneumocystis pneumonia, tuberculous meningitis). In multivariate analyses, having PHIV, being <20 years of age, and having anogenital high-risk human papillomavirus (HPV) infection with types 16 and/or 18 increased risk of SAEs. Among PHIV youth, CD4 count <350 cells/mm3, HIV-RNA ≥1,000 copies/mL, advanced WHO stages, and having anogenital HPV 16 and/or 18 infection predicted higher incidence of SAEs; no prior use of alcohol was protective. These data emphasize the need for tailored interventions for adolescents with PHIV to prevent long-term morbidity and mortality.
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Affiliation(s)
- Thida Singtoroj
- TREAT Asia/amfAR–The Foundation for AIDS Research, Bangkok, Thailand
| | - Sirinya Teeraananchai
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sivaporn Gatechompol
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | - Stephen Kerr
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Annette H. Sohn
- TREAT Asia/amfAR–The Foundation for AIDS Research, Bangkok, Thailand
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Ahmed CV, Brooks MJ, DeLong SM, Zanoni BC, Njuguna I, Beima-Sofie K, Dow DE, Shayo A, Schreibman A, Chapman J, Chen L, Mehta S, Mbizvo MT, Lowenthal ED. Impact of COVID-19 on Adolescent HIV Prevention and Treatment Services in the AHISA Network. AIDS Behav 2023; 27:84-93. [PMID: 36574183 PMCID: PMC9792928 DOI: 10.1007/s10461-022-03959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
We investigated perceived impacts of COVID-19 on the delivery of adolescent HIV treatment and prevention services in sub-Saharan Africa (SSA) by administering a survey to members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) from February to April 2021. We organized COVID-19 impacts, as perceived by AHISA teams, under three themes: service interruptions, service adjustments, and perceived individual-level health impacts. AHISA teams commonly reported interruptions to prevention programs, diagnostic testing, and access to antiretroviral therapy (ART). Common service adjustments included decentralization of ART refills, expanded multi-month ART distribution, and digital technology use. Perceived individual-level impacts included social isolation, loss to follow-up, food insecurity, poverty, and increases in adolescent pregnancies and sexually transmitted infections. The need for collaboration among stakeholders were commonly cited as lessons learned by AHISA teams. Survey findings highlight the need for implementation science research to evaluate the effects of pandemic-related HIV service adaptations in SSA.
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Affiliation(s)
- Charisse V Ahmed
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Merrian J Brooks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Children's Hospital of Philadelphia Global Health Center, Philadelphia, PA, USA
| | - Stephanie M DeLong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian C Zanoni
- Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Irene Njuguna
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Dorothy E Dow
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Aisa Shayo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Jennifer Chapman
- Children's Hospital of Philadelphia Global Health Center, Philadelphia, PA, USA
| | - Lydia Chen
- University of Pennsylvania, Philadelphia, PA, USA
| | - Shreya Mehta
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Elizabeth D Lowenthal
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Children's Hospital of Philadelphia Global Health Center, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- CHOP Roberts Center for Pediatric Research, 734 Schuylkill Ave, 19146, Philadelphia, PA, USA.
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Zhou Y, Tang K, Lu H, Chen H, Xie H, Li Z, Huang J, Fang N, Chen S, Wang H, He Q, Chen H, Liu X, Lan G, Zhu Q, Chen Y, Zhang X, Ruan Y, Liang S. Behavioral and emotional difficulties and HIV treatment outcomes among HIV-infected children in rural southwestern China. Child Adolesc Psychiatry Ment Health 2023; 17:51. [PMID: 37072804 PMCID: PMC10114443 DOI: 10.1186/s13034-023-00601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Previous studies have not clearly demonstrated the impact of behavioral and emotional problems (BEDs) on treatment outcomes among HIV-infected children on antiretroviral therapy (ART). This study aimed to describe the prevalence of BEDs among this population and identify the factors associated with HIV treatment outcomes. METHODS This cross-sectional study was conducted in Guangxi, China, between July and August 2021. HIV-infected children answered questionnaires about BEDs, physical health, social support, and whether they have missed doses in the past month. BEDs were assessed using the Chinese version of the self-reported Strengths and Difficulties Questionnaire (SDQ-C). The self-reported survey data were linked to participants' HIV care information that was obtained from the national surveillance database. Univariate and multivariate logistic regression models were used to identify factors that were associated with missed doses in the past month and virological failure. RESULTS The study sample was 325 HIV-infected children. HIV-infected children had a higher proportion of abnormal scores on SDQ-C total difficulties compared to their peers in the general population (16.9 vs 10.0%; P = 0.002). An abnormal SDQ-C total difficulties score (AOR = 2.06, 95%CI: 1.10-3.88) and infrequency of receiving assistance and support from parents over the past 3 months (AOR = 1.85, 95%CI: 1.12-3.06) were significantly associated with missed doses in the past month. Between the ages of 14-17 years (AOR = 2.66, 95% CI: 1.37-5.16), female (AOR = 2.21, 95% CI: 1.20-4.08), and suboptimal adherence (AOR = 2.45, 95% CI: 1.32-4.57) were significantly associated with virological failure. CONCLUSIONS Children's mental health plays a role in HIV treatment outcomes. Psychological interventions should be promoted in pediatric HIV care clinics to improve children's mental health status and HIV treatment outcomes.
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Affiliation(s)
- Yesheng Zhou
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Kailing Tang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Hongyan Lu
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Hongli Chen
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Haomin Xie
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Zeyu Li
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Jinghua Huang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Ningye Fang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Siya Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Hong Wang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Qin He
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Huanhuan Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiu Liu
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Guanghua Lan
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Qiuying Zhu
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Yi Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiangjun Zhang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
| | - Shujia Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China.
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Sekine Y, Kawaguchi T, Kunimoto Y, Masuda J, Numata A, Hirano A, Yagura H, Ishihara M, Hikasa S, Tsukiji M, Miyaji T, Yamaguchi T, Kinai E, Amano K. Adherence to anti-retroviral therapy, decisional conflicts, and health-related quality of life among treatment-naïve individuals living with HIV: a DEARS-J observational study. J Pharm Health Care Sci 2023; 9:9. [PMID: 36859482 PMCID: PMC9979481 DOI: 10.1186/s40780-023-00277-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Supporting people living with HIV using anti-retroviral therapy (ART) is important due to the requirement for strict medication adherence. To date, no data from longitudinal studies evaluating adherence by treatment-naïve people living with HIV are currently available. We investigated the adherence of treatment-naïve people living with HIV over time and examined the relationships among decisional conflicts, adherence, and health-related quality of life (HRQL). METHODS The survey items included adherence (visual analogue scale [VAS]), decisional conflict (decisional conflict scale [DCS]), and HRQL (Medical Outcomes Study HIV Health Survey [MOS-HIV]). The DCS and MOS-HIV scores and the VAS and MOS scores were collected electronically at the ART initiation time point and at 4-, 24-, and 48-week post-treatment time points. RESULTS A total of 215 participants were enrolled. The mean DCS score was 27.3 (SD, 0.9); 23.3% of participants were in the high-score and 36.7% in the low-score groups. The mean adherence rates at 4, 24, and 48 weeks were 99.2% (standard error [SE], 0.2), 98.4% (SE, 0.4), and 96.0% (SE, 1.2), respectively. The least-square means of the MOS-HIV for the DCS (high vs. low scores) were 64.4 vs. 69.2 for general health perceptions and 57.7 vs. 64.0 for HRQL, respectively. CONCLUSION Adherence among treatment-naïve people living with HIV was maintained at a higher level, and HRQL tended to improve with ART. People with high levels of decisional conflict tended to have lower HRQL scores. Support for people living with HIV during ART initiation may be related to HRQL.
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Affiliation(s)
- Yusuke Sekine
- Department of Pharmacy, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Takashi Kawaguchi
- grid.410785.f0000 0001 0659 6325Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yusuke Kunimoto
- grid.470107.5Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Junichi Masuda
- grid.45203.300000 0004 0489 0290Department of Pharmacy, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Ayako Numata
- grid.45203.300000 0004 0489 0290Department of Pharmacy, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Hirano
- grid.410840.90000 0004 0378 7902Department of Pharmacy, National Hospital organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroki Yagura
- grid.416803.80000 0004 0377 7966Department of Pharmacy, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masashi Ishihara
- grid.411704.7Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Shinichi Hikasa
- grid.272264.70000 0000 9142 153XDepartment of Pharmacy, Hyogo Medical University Hospital, Hyogo, Japan
| | - Mariko Tsukiji
- grid.411321.40000 0004 0632 2959Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Tempei Miyaji
- grid.69566.3a0000 0001 2248 6943Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- grid.69566.3a0000 0001 2248 6943Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ei Kinai
- grid.410793.80000 0001 0663 3325Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kagehiro Amano
- grid.410793.80000 0001 0663 3325Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
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Lindsey JC, Hudgens M, Gaur AH, Horvath KJ, Dallas R, Heckman B, Johnson MM, Amico KR. Electronic Dose Monitoring Device Patterns in Youth Living With HIV Enrolled in an Adherence Intervention Clinical Trial. J Acquir Immune Defic Syndr 2023; 92:231-241. [PMID: 36730762 PMCID: PMC9928806 DOI: 10.1097/qai.0000000000003126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/24/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Youth living with HIV in the US have low rates of viral suppression, in part because of challenges with antiretroviral therapy adherence. METHODS Daily dosing in the Adolescent Medicine Trials Network for HIV/AIDS Interventions 152 study, a randomized controlled trial of a 12-week adherence intervention (triggered escalating real-time adherence intervention) for viremic youth, compared with standard of care (SOC), was measured by electronic dose monitoring (EDM) throughout 48 weeks of follow-up. EDM data collected over the first 24 weeks were used to characterize patterns of antiretroviral therapy adherence with group-based trajectory models. RESULTS Four trajectory groups were identified among the 85 participants included in the analysis during the intervention phase of the study: (Worst) no interaction with EDM, (Declining) initially moderate EDM-based adherence followed by steep declines, (Good) initially high EDM-based adherence with modest declines, and (Best) consistently high EDM-based adherence. Being in the SOC arm, not being in school, higher evasiveness and panic decision-making scores, and lower adherence motivation were associated with higher odds of being in a worse trajectory group ( P < 0.05). A general decline in dosing was observed in the 12 weeks postintervention, when all participants were managed using SOC. CONCLUSIONS Use of group-based trajectory models allowed a more nuanced understanding of EDM-based adherence over time compared with collapsed summary measures. In addition to the study intervention, other factors influencing EDM-based adherence included being in school, decision-making styles, and adherence-related motivation. This information can be used to design better intervention services for youth living with HIV.
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Affiliation(s)
- Jane C. Lindsey
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, US
| | - Michael Hudgens
- University of North Carolina at Chapel Hill, Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, NC, US
| | - Aditya H. Gaur
- St. Jude Children’s Research Hospital, Department of Infectious Diseases, Memphis, TN, US
| | | | - Ronald Dallas
- St. Jude Children’s Research Hospital, Department of Infectious Diseases, Memphis, TN, US
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Inc., Amherst, NY, US
| | - Megan Mueller Johnson
- University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI, US
| | - K Rivet Amico
- University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI, US
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Diura-Vere O, Mokgatle MM, Oguntibeju OO. Sexual Behaviour and Attitudes towards Safe Sex of Youth Receiving Antiretroviral Care at Public Health Facilities in Palapye District, Botswana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3790. [PMID: 36900803 PMCID: PMC10001564 DOI: 10.3390/ijerph20053790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sexual behaviour of HIV-infected youths is very important in determining the direction of the HIV epidemic, as these youths are reservoirs of HIV and can propagate its transmission if they engage in risky sexual behaviours. However, support structures for secondary prevention are weak even in healthcare settings. There is a need to understand the sexual behaviour of these youths and, in turn, tailor appropriate secondary prevention strategies, hence the current study was designed to assess sexual behaviour and attitudes towards safe sex of youth receiving antiretroviral care at public health facilities in Palapye district, Botswana. METHOD This quantitative, descriptive cross-sectional survey was used to describe the sexual behaviour and attitudes towards safe sex and identify factors associated with risky sexual behaviours among HIV-infected youths aged between 15 and 19 years receiving antiretroviral therapy (ART) care from public healthcare facilities in Palapye District, Botswana. RESULTS A total of 188 youths participated in this study, 56% being females while 44% were males. We reported that 15.4% had ever had sex. At their last sexual encounter, more than half of the youths (51.7%) had not used condoms. More than a third of the participants were under the influence of alcohol during their last sexual experience. Generally, the youths had good attitudes towards safe sex, as most youths said they would prioritise protecting their sexual partners and themselves from HIV and STIs. Alcohol use, substance use and not considering religion as important were strongly associated with having ever had sex. CONCLUSIONS A significant proportion of HIV-infected youths are sexually active, whereas their preventive practices such as condom use are poor despite good attitudes towards safe sex. Alcohol use, substance use and not perceiving religion as important were associated with risky sexual behaviours.
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Affiliation(s)
- Onai Diura-Vere
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Mathildah M. Mokgatle
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Oluwafemi O. Oguntibeju
- Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa
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Beichler H, Grabovac I, Dorner TE. Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3374. [PMID: 36834069 PMCID: PMC9965658 DOI: 10.3390/ijerph20043374] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
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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Affiliation(s)
- Helmut Beichler
- Nursing School, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas E. Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria
- Academy for Ageing Research, Haus der Barmherzigkeit, 1090 Vienna, Austria
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Ng'ong'a GO, Lwembe RM, Knight V, Randa D, Ściborski RJ, Ayodo G. Association of ART Non-adherence with Self-reported behavior and lifestyle among injecting drug users in the coastal region of Kenya. SCIENTIFIC AFRICAN 2023. [DOI: 10.1016/j.sciaf.2023.e01598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Nguyen N, Lovero KL, Falcao J, Brittain K, Zerbe A, Wilson IB, Kapogiannis B, Pimentel De Gusmao E, Vitale M, Couto A, Simione TB, Abrams EJ, Mellins CA. Mental health and ART adherence among adolescents living with HIV in Mozambique. AIDS Care 2023; 35:182-190. [PMID: 35277102 PMCID: PMC10243515 DOI: 10.1080/09540121.2022.2032574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 01/17/2022] [Indexed: 10/18/2022]
Abstract
Little is known about the mental health needs of adolescents living with HIV (ALWH) in Mozambique, including the potential relationship between mental health challenges and poor antiretroviral treatment (ART) adherence. We examined mental health problems (anxiety, depression, post-traumatic stress disorder [PTSD] symptoms and impairment) and their association with self-reported ART adherence among ALWH ages 15-19 in Nampula, Mozambique. The associations between each mental health problem area and sub-optimal adherence were estimated using logistic regression, controlling for age, education, and social support, with interaction by gender. Males had significantly higher anxiety (5.6 vs 4.3, p = 0.01), depression (5.8 vs 4.1, p = 0.005), and PTSD (13.3 vs 9.8, p = 0.02) symptoms and impairment (1.8 vs 0.56, p<0.0001) scores than females. Proportion reporting sub-optimal adherence (65%) did not differ by gender. Higher anxiety, depression, and PTSD symptom and impairment scores were significantly associated with higher odds of sub-optimal ART adherence in males but not females. Among Mozambican ALWH, mental health problems were prevalent and two-thirds had ART adherence less than 90%. Worse mental health was associated with increased odds of sub-optimal ART adherence in males but not females. Interventions are needed to address mental health problems and improve ART adherence in Mozambican ALWH, particularly among males.
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Affiliation(s)
- Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
- Aaron Diamond AIDS Research Center, Columbia University, New York, USA
| | - Kathryn L Lovero
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Joana Falcao
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| | - Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| | - Ira B Wilson
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | | | - Mirriah Vitale
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| | - Aleny Couto
- National STI, HIV/AIDS Control Program, Maputo, Mozambique
| | - Teresa Beatriz Simione
- National STI, HIV/AIDS Control Program, Maputo, Mozambique
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
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Puplampu P, Asamoah I, Asare BO, Berko KP, Oladele O, Amankwa E, Lambert F, Afriyie AT, Ganu V. Cryptococcal meningitis among perinatally HIV-infected adolescents: Case series on presentation and management challenges. Clin Case Rep 2023; 11:e6995. [PMID: 36852119 PMCID: PMC9958000 DOI: 10.1002/ccr3.6995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/27/2023] Open
Abstract
Diagnosis and management of cryptococcal meningitis in HIV-infected adolescents is challenging in poor resource settings. A high index of suspicion based on clinical presentation is critical for early identification and treatment. This report sought to describe the clinical presentation and outcomes of HIV-associated cryptococcal meningitis in adolescents.
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Affiliation(s)
- Peter Puplampu
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Isabella Asamoah
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Bismark O. Asare
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Kofi P. Berko
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | | | | | - Frempong Lambert
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | | | - Vincent Ganu
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
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Saberi P, Stoner MC, Eskaf S, Ndukwe S, Campbell CK, Sauceda JA, Dubé K. Preferences for HIV Treatment Formulations Among Young Adults With HIV in the United States. J Acquir Immune Defic Syndr 2023; 92:e7-e10. [PMID: 36343377 PMCID: PMC9839471 DOI: 10.1097/qai.0000000000003128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Parya Saberi
- Division of Prevention Science; University of California, San Francisco; San Francisco, CA, USA
| | | | - Shadi Eskaf
- Independent Public Health Researcher/Consultant, Chapel Hill, NC, USA
| | - Samuel Ndukwe
- Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill, NC, USA
| | - Chadwick K. Campbell
- Division of Prevention Science; University of California, San Francisco; San Francisco, CA, USA
| | - John A. Sauceda
- Division of Prevention Science; University of California, San Francisco; San Francisco, CA, USA
| | - Karine Dubé
- Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill, NC, USA
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Li H, Shah SK, Healy E, Agot K, Neary J, Wilson K, Badia J, Atieno WO, Moraa H, Meischke H, Kibugi J, Inwani I, Chhun N, Mukumbang FC, John‐Stewart G, Kohler P, Beima‐Sofie K. "[T]he laws need to change to reflect current society": Insights from stakeholders involved in development, review or implementation of policies about adolescent consent for HIV testing, care and research in Kenya. J Int AIDS Soc 2023; 26:e26057. [PMID: 36642867 PMCID: PMC9841068 DOI: 10.1002/jia2.26057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Engaging adolescents in HIV care and research promotes the development of interventions tailored to their unique needs. Guidelines generally require parental permission for adolescents to receive HIV care/testing or participate in research, with exceptions. Nevertheless, parental permission requirements can restrict adolescent involvement in care and research. To better appreciate prospects for policy reform, we sought to understand the perspectives of stakeholders involved in the development, review and implementation of policies related to adolescents living with HIV. METHODS Semi-structured individual interviews (IDIs) were conducted from October 2019 to March 2020 with 18 stakeholders with expertise in the (1) development of policy through membership in the Law Society of Kenya or work as a health policy official; (2) review of policy through ethics review committee service; or (3) implementation of policy through involvement in adolescent education. IDIs were conducted in English by Kenyan social scientists, audio-recorded and transcribed verbatim. We used thematic analysis to identify themes around how policies can be reformed to improve adolescent engagement in HIV care and research. RESULTS Our analysis identified three major themes. First, policies should be flexible rather than setting an age of consent. Stakeholders noted that adolescents' capacity for engagement in HIV care and research depended on context, perceived risks and benefits, and "maturity"-and that age was a poor proxy for the ability to understand. Second, policies should evolve with changing societal views about adolescent autonomy. Participants recognized a generational shift in how adolescents learn and mature, suggesting the need for a more frequent review of HIV care and research guidelines. Third, adults should empower adolescent decision-making. Stakeholders felt that caregivers can gradually involve adolescents in decision-making to equip them to gain ownership over their health and lives, improving their confidence and capacity. CONCLUSIONS Revising relevant laws to consider context, alternative measures of maturity, and evolving societal views about adolescence, along with supporting caregivers to assist in developing adolescent autonomy may promote more equitable and representative participation of adolescents in HIV care and research. Additional research should explore how to support caregivers and other adults to empower adolescents and improve stakeholder engagement in a more routine process of policy reform.
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Affiliation(s)
- Huangqianyu Li
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - Seema K. Shah
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Bioethics Program at Lurie Children's HospitalChicagoIllinoisUSA
| | - Elise Healy
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Kawango Agot
- Impact Research and Development OrganizationKisumuKenya
| | - Jillian Neary
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Kate Wilson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Jacinta Badia
- Impact Research and Development OrganizationKisumuKenya
| | | | - Hellen Moraa
- Department of Pediatrics and Child HealthUniversity of NairobiNairobiKenya
| | - Hendrika Meischke
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - James Kibugi
- Impact Research and Development OrganizationKisumuKenya
| | - Irene Inwani
- University of Nairobi/Kenyatta National HospitalNairobiKenya
| | - Nok Chhun
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Pamela Kohler
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of ChildFamily and Population Health NursingUniversity of WashingtonSeattleWashingtonUSA
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Hlophe LD, Tamuzi JL, Shumba CS, Nyasulu PS. Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis. PLoS One 2023; 18:e0276411. [PMID: 37200399 DOI: 10.1371/journal.pone.0276411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) significantly affects adolescents globally, with the sub-Saharan Africa (SSA) reporting a high burden of the disease. HIV testing, treatment, and retention to care are low among adolescents. We conducted a mixed-method systematic review to assess anti-retroviral therapy (ART) adherence; barriers and facilitators to ART adherence and ART outcomes among adolescents living with HIV and on ART in sub-Saharan Africa. METHODS We conducted searches in four scientific databases for studies conducted between 2010 and March 2022 to identify relevant primary studies. Studies were screened against inclusion criteria and assessed for quality, and data was extracted. Meta-analysis of rates and odd ratios was used to plot the quantitative studies and meta-synthesis summarized the evidence from qualitative studies. RESULTS A total of 10 431 studies were identified and screened against the inclusion/ exclusion criteria. Sixty-six studies met the inclusion criteria (41 quantitative, 16 qualitative, and 9 mixed-methods study designs). Fifty-three thousand two hundred and seventeen (53 217) adolescents (52 319 in quantitative studies and 899 in qualitative studies) were included in the review. Thirteen support focused interventions for improved ART adherence were identified from quantitative studies. The plotted results from the meta-analysis found an ART adherence rate of 65% (95%CI 56-74), viral load suppression was 55% (95%CI 46-64), un-suppressed viral load rate of 41% (95%CI 32-50), and loss to follow up of 17% (95%CI 10-24) among adolescents. Meta-synthesis found six themes of barriers to ART (social, patient-based, economic, health system-based, therapy-based, and cultural barriers) in both the qualitative and quantitative studies, and three themes of facilitators to ART were also identified (social support, counselling, and ART education and secrecy or confidentiality) from qualitative studies. CONCLUSION ART adherence remains low among adolescents in SSA despite multiple interventions implemented to improve ART adherence. The low adherence rate may hinder the attainment of the UNAIDS 2030 targets. Additionally, various barriers to ART adherence due to lack of support have been reported among this age group. However, interventions aimed at improving social support, educating, and counselling adolescents may improve and sustain ART adherence. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42021284891.
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Affiliation(s)
- Londiwe D Hlophe
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Environmental Health Sciences, Faculty of Health Sciences, University of Eswatini, Mbabane, Kingdom of Eswatini
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Game-based health education to improve ART adherence of newly diagnosed young people with HIV: protocol for a stepped-wedge design randomized controlled trial. BMC Public Health 2022; 22:2251. [PMID: 36460991 PMCID: PMC9719159 DOI: 10.1186/s12889-022-14708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) is one of the most effective ways for HIV-infected to treat AIDS. However, it is difficult to start ART among young people those newly diagnosed HIV-infection in China, and their adherence to ART is poor. We have designed an AIDS educational game called AIDS Fighter · Health Defense, which could improve the AIDS-related knowledge and has the potential to improve AIDS prevention ability of young students. In this study, AIDS Fighter · Health Defense will be used with newly diagnosed young people with HIV to evaluate the education effect of the game in improving ART adherence. DESIGN A stepped-wedge design randomized controlled trial will be conducted to confirm the education effect of AIDS Fighter · Health Defense on improving ART adherence of newly diagnosed young people with HIV, and to verify when to start game-based health education could be more effective for newly diagnosed young people with HIV. METHODS Participants will receive AIDS education from health workers and start ART when diagnosed with HIV and assigned into four groups randomly. The first step group to the fourth step group will receive AIDS Fighter · Health Defense in turn at the star of ART, one week, one month and three months after the start of ART. The primary outcomes are medication adherence, CD4( +) T cell count, and HIV viral load. The secondary outcomes are ART-related knowledge, ART-related skills, psychological resilience, and self-discrimination. Assessments will be completed before the intervention and one week, first month, and third month of the intervention, and then a one-year follow-up evaluation will be conducted after the intervention. DISCUSSION AIDS Fighter · Health Defense may be an effective approach to help newly diagnosed young people with HIV to improve ART adherence. A stepped-wedge design randomized controlled trial of this study may find the optimal time of AIDS education to improve ART adherence of newly diagnosed young people with HIV. REGISTRATION NUMBER Chinese Clinical Trial Registry: ChiCTR2200059766, registered 11 May 2022. http://www.chictr.org.cn/showproj.aspx?proj=169420.
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Impact of conditional economic incentives and motivational interviewing on health outcomes of adolescents living with HIV in Anambra State, Nigeria: A cluster-randomised trial. Contemp Clin Trials Commun 2022; 30:100997. [PMID: 36147247 PMCID: PMC9486535 DOI: 10.1016/j.conctc.2022.100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Adolescents living with HIV (ALHIV) have had worse outcomes compared to adults. They face enormous difficulty in accessing HIV care services. We hypothesize that conditional economic incentives (CEI) and motivational interviewing could increase retention in care, medication adherence and ultimately viral load suppression. Therefore, we evaluated the one-year impact of conditional economic incentives and motivational interviewing on the health outcomes of ALHIV in Anambra State, Nigeria. Methods Using a cluster-randomised design, we examined the one-year (from December 1, 2018, to November 30, 2019), individual-level impact of an Incentive Scheme comprising conditional economic incentives and motivational interviewing on achieving undetectable viral load (primary outcome), CD4+ count, adherence to antiretroviral therapy and retention in care (secondary outcomes) by ALHIV in Anambra State, Nigeria. Twelve HIV treatment hospitals were stratified according to the type of clinic (secondary or tertiary) and randomly assigned to the intervention arm or control arm to receive the Incentive Scheme or routine care, respectively. ALHIV aged 10–19 years, initiated into HIV care for a minimum of 6 months, and who adhered poorly to medications (<100% adherence rate) were eligible for the study. Participants in the intervention arm received motivational interviewing at the study baseline and every visit. They also received US$5.6 when HIV viral load (VL) was <20 copies/mL at month 3, US$2.8 if the VL remained suppressed at months 6 and 9, and US$5.6 if the VL remained <20 copies/mL at month 12. Results Of the 246 trial participants, 119 were in the intervention while 127 were in the control arm. There was no difference in the baseline characteristics of the participants between the intervention and control arm except for the number of participants with undetectable viral load and the number of participants with ≥95% adherence. Although participants in the intervention arm had a 10.1% increase while those in the control arm had a 1.6% decrease in proportion with undetectable viral load (≤20 copies/ml) after 12 months, the change in the primary outcome was not statistically significant. Similarly, the differences in the secondary outcomes were not statistically significant. Conclusion The Incentive Scheme did not improve the virologic outcome of ALHIV after 12 months. Differences in the secondary outcomes after 12 months were also not significantly different from the baseline. Trial registration We registered the trial retrospectively with The Pan African Clinical Trials Registry: https://pactr.samrc.ac.za/(PACTR201806003040425) on 2/2/2018.
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