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Gebrie M, Perry L, Xu X, Kassa A, Cruickshank M. Nutritional status and its determinants among adolescents with HIV on anti-retroviral treatment in low- and middle-income countries: a systematic review and meta-analysis. BMC Nutr 2023; 9:60. [PMID: 36978175 PMCID: PMC10053752 DOI: 10.1186/s40795-023-00714-z] [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: 11/21/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE This review aimed to determine what methods are used to assess nutritional status, the levels of nutritional status, determinants of undernutrition, and nutritional interventions employed for adolescents with HIV on Anti-Retroviral Therapy follow-up in Low- and Middle-Income countries. METHODS Established methods were used to systematically identify and retrieve studies published in five databases between January 2000 to May 2021, and citation searching. Quality was appraised and findings were synthesized using narrative analysis and meta-analysis. RESULT Body Mass Index is the major indicator of nutritional status. The pooled prevalence of stunting, wasting, and overweight were 28.0%, 17.0%, and 5.0%, respectively. Adolescent males are 1.85 and 2.55 times more likely than adolescent females to suffer from both stunting and wasting at AOR = 1.85 (95%:1.47, 2.31) and AOR = 2.55 (95%: 1.88, 3.48), respectively. Similarly, adolescents with a history of opportunistic infections were 2.97 times more likely to be stunted than uninfected adolescents, AOR = 2.97 (95%:1.73, 5.12). One single intervention study found significant improvements in anthropometric status after nutritional supplementation. CONCLUSION AND RECOMMENDATION The few studies that have been conducted on nutritional status in adolescents living with HIV in low- and middle-income countries indicate that stunting and wasting are common in this population. Avoiding opportunistic infections is an important protective factor but the review highlighted the generally inadequate and fragmented nature of nutritional screening and support programs. Development of comprehensive and integrated systems for nutritional assessment and intervention services during ART follow-up should be prioritized to improve adolescent clinical outcomes and survival.
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Affiliation(s)
- Meless Gebrie
- College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia.
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Xiaoyue Xu
- School of Population Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Andargachew Kassa
- College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Marilyn Cruickshank
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Sydney Children's Hospitals Network, Sydney, Australia
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How gender is socially constructed in policy making processes: a case study of the Adolescent and Youth Health Policy in South Africa. Int J Equity Health 2023; 22:36. [PMID: 36829217 PMCID: PMC9955531 DOI: 10.1186/s12939-022-01819-w] [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: 12/16/2021] [Accepted: 12/22/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Gender equality remains an outstanding global priority, more than 25 years after the landmark Beijing Platform for Action. The disconnect between global health policy intentions and implementation is shaped by several conceptual, pragmatic and political factors, both globally and in South Africa. Actor narratives and different framings of gender and gender equality are one part of the contested nature of gender policy processes and their implementation challenges. The main aim of this paper is to foreground the range of policy actors, describe their narratives and different framings of gender, as part exploring the social construction of gender in policy processes, using the Adolescent Youth Health Policy (AYHP) as a case study. METHODS A case study design was undertaken, with conceptual underpinnings combined from gender studies, sociology and health policy analysis. Through purposive sampling, a range of actors were selected, including AYHP authors from government and academia, members of the AYHP Advisory Panel, youth representatives from the National Department of Health Adolescent and Youth Advisory Panel, as well as adolescent and youth health and gender policy actors, in government, academia and civil society. Qualitative data was collected via in-depth, semi-structured interviews with 30 policy actors between 2019 and 2021. Thematic data analysis was used, as well as triangulation across both respondents, and the document analysis of the AYHP. RESULTS Despite gender power relations and more gender-transformative approaches being discussed during the policy making process, these were not reflected in the final policy. Interviews revealed an interrelated constellation of diverse and juxtaposed actor gender narratives, ranging from framing gender as equating girls and women, gender as inclusion, gender as instrumental, gender as women's rights and empowerment and gender as power relations. Some of these narrative framings were dominant in the policy making process and were consequently included in the final policy document, unlike other narratives. The way gender is framed in policy processes is shaped by actor narratives, and these diverse and contested discursive constructions were shaped by the dynamic interactions with the South Africa context, and processes of the Adolescent Youth Health Policy. These varied actor narratives were further contextualised in terms of reflections of what is needed going forward to advance gender equality in adolescent and youth health policy and programming. This includes prioritising gender and intersectionality on the national agenda, implementing more gender-transformative programmes, as well as having the commitments and capabilities to take the work forward. CONCLUSIONS The constellation of actors' gender narratives reveals overlapping and contested framings of gender and what is required to advance gender equality. Understanding actor narratives in policy processes contributes to bridging the disconnect between policy commitments and reality in advancing the gender equality agenda.
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Jacobs T, George A, De Jong M. Policy foundations for transformation: a gender analysis of adolescent health policy documents in South Africa. Health Policy Plan 2021; 36:684-694. [PMID: 33852727 PMCID: PMC8248976 DOI: 10.1093/heapol/czab041] [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: 07/14/2020] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
The Sustainable Development Goals (SDGs) and the United Nations Global Strategy
(2016–30) emphasize that all women, children and adolescents
‘survive, thrive and transform’. A key element of this global
policy framework is that gender equality is a stand-alone goal as well as a
cross-cutting priority. Gender inequality and intersecting social and structural
determinants shape health systems, including the content of policy documents,
with implications for implementation. This article applies a gender lens to
policy documents by national government bodies that have mandates on adolescent
health in South Africa. Data were 15 policy documents, authored between 2003 and
2018, by multiple actors. The content analysis was guided by key lines of
enquiry, and policy documents were classified along the continuum of gender
blind to gender transformative. Only three policy documents defined gender, and
if gender was addressed, it was mostly in gender-sensitive ways, at times gender
specific, but rarely gender transformative. Building on this, a critical
discourse analysis identified what is problematized and what is left
unproblematized by actors, identifying the key interrelated dominant and
marginalized discourses, as well as the ‘silences’ embedded in
policy documents. The discourse analysis revealed that dominant and marginalized
discourses reflect how gender is conceptualized as fixed, categorical
identities, vs as fluid social processes, with implications for how rights and
risks are understood. The discourses substantiate an over-riding focus on
adolescent girls, outside of the context of power relations, with minimal
attention to boys in terms of their own health or through a gender lens, as well
as little consideration of LGBTIQ+ adolescents beyond HIV. Dynamic and
complex relationships exist between the South Africa context, actors, content
and processes, in shaping both how gender is problematized and how
‘solutions’ are represented in these policies. How gender is
conceptualized matters, both for policy analysis and for praxis, and policy
documents can be part of foundations for transforming gender and intersecting
power relations.
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Affiliation(s)
- Tanya Jacobs
- School of Public Health, University of the Western Cape, Bellville, Robert Sobukwe Rd, Western Cape 7535, South Africa
| | - Asha George
- School of Public Health, University of the Western Cape, Bellville, Robert Sobukwe Rd, Western Cape 7535, South Africa
| | - Michelle De Jong
- School of Public Health, University of the Western Cape, Bellville, Robert Sobukwe Rd, Western Cape 7535, South Africa
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Disclosure, Social Support, and Mental Health are Modifiable Factors Affecting Engagement in Care of Perinatally-HIV Infected Adolescents: A Qualitative Dyadic Analysis. AIDS Behav 2021; 25:237-248. [PMID: 32638220 DOI: 10.1007/s10461-020-02968-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adolescents living with perinatally acquired HIV in South Africa face significant barriers to successful transition from pediatric to adult care. We performed in-depth qualitative interviews with 41 adolescents living with HIV and 18 of their caregivers to investigate modifiable factors to improve engagement in care prior to transition to adult care. Based on dyadic, inductive content analysis, findings suggest that HIV status disclosure, social support, and mental health are targets for improvement in engagement in care. Early disclosure and a sense of belonging facilitated engagement in care, while barriers included delayed or inadequate disclosure, denial, and lack of disclosure to others. Adherence support improved by having a biological mother as a direct supervisor. Barriers to care included changing caregivers, abandonment, undiagnosed mental health problems and learning difficulties. Despite these factors, the majority of adolescents showed resilience and remained engaged in care despite difficult circumstances.
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Bhana A, Abas MA, Kelly J, van Pinxteren M, Mudekunye LA, Pantelic M. Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review. BJPsych Open 2020; 6:e104. [PMID: 32886056 PMCID: PMC7488323 DOI: 10.1192/bjo.2020.67] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective. AIMS This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269). METHOD A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10-24 years) in LMICs. RESULTS Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver-adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only. CONCLUSIONS Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.
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Affiliation(s)
- Arvin Bhana
- Health Systems Research Unit, South African Medical Research Council, South Africa; and Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Melanie Amna Abas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jane Kelly
- Policy and Research Directorate, Department of Community Safety, Western Cape Government, South Africa
| | - Myrna van Pinxteren
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Marija Pantelic
- Department of Social Policy and Intervention, Oxford University, UK; Frontline AIDS, UK; and Department of Medical Education, Brighton and Sussex Medical School, UK
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Cluver LD, Orkin FM, Campeau L, Toska E, Webb D, Carlqvist A, Sherr L. Improving lives by accelerating progress towards the UN Sustainable Development Goals for adolescents living with HIV: a prospective cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 3:245-254. [PMID: 30878118 PMCID: PMC6559259 DOI: 10.1016/s2352-4642(19)30033-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 11/12/2022]
Abstract
Background Low-income and middle-income countries (LMICs) face major challenges in achieving the UN's Sustainable Development Goals (SDGs) for vulnerable adolescents. We aimed to test the UN Development Programme's proposed approach of development accelerators—provisions that lead to progress across multiple SDGs—and synergies between accelerators on achieving SDG-aligned targets in a highly vulnerable group of adolescents in South Africa. Methods We did standardised interviews and extracted longitudinal data from clinical records at baseline (2014–15) and 18-month follow-up (2016–17) for adolescents aged 10–19 years living with HIV in the Eastern Cape province of South Africa. We used standardised tools to measure 11 SDG-aligned targets—antiretroviral therapy adherence, good mental health, no substance use, HIV care retention, school enrolment, school progression, no sexual abuse, no high-risk sex, no violence perpetration, no community violence, and no emotional or physical abuse. We also assessed receipt at both baseline and follow-up of six hypothesised development accelerators—government cash transfers to households, safe schools (ie, without teacher or student violence), free schools, parenting support, free school meals, and support groups. Associations of all provisions with SDG-aligned targets were assessed jointly in a multivariate path model, controlling for baseline outcomes and sociodemographic and HIV-related covariates, and adjusted for multiple outcome testing. Cumulative effects were tested by marginal effects modelling. Findings 1063 (90%) of 1176 eligible adolescents were interviewed. Three provisions were shown to be development accelerators. Parenting support was associated with good mental health (odds ratio 2·13, 95% CI 1·43–3·15, p<0·0001), no high-risk sex (2·44, 1·45–5·03, p=0·005), no violence perpetration (2·59, 1·63–4·59, p<0·0001), no community violence (2·43, 1·65–3·86, p<0·0001), and no emotional or physical abuse (2·38, 1·65–3·76; p<0·0001). Cash transfers were associated with HIV care retention (1·87, 1·15–3·02, p=0·010), school progression (2·05, 1·33–3·24, p=0·003), and no emotional or physical abuse (1·76, 1·12–3·02, p=0·025). Safe schools were associated with good mental health (1·74, 1·30–2·34, p<0·0001), school progression (1·57, 1·17–2·13, p=0·004), no violence perpetration (2·02, 1·45–2·91, p<0·0001), no community violence (1·81, 1·30–2·55, p<0·0001), and no emotional or physical abuse (2·20, 1·58–3·17, p<0·0001). For five of 11 SDG-aligned targets, a combination of two or more accelerators showed cumulative positive associations, suggesting accelerator synergies of combination provisions. For example, the fitted probability of adolescents reporting no emotional or physical abuse (SDG 16.2) with no safe schools, cash transfers, or parenting support was 0·25 (0·16–0·34). With cash transfer alone it was 0·37 (0·33–0·42), with safe school alone 0·42 (0·30–0·55), and with parenting support alone 0·44 (0·30–0·59). With all three development accelerators combined, the probability of adolescents reporting no emotional or physical abuse was 0·76 (0·67–0·84). After correcting for multiple tests, four of the SDG-aligned targets (antiretroviral therapy adherence, no substance use, school enrolment, and no sexual abuse) were not associated with any hypothesised accelerators. Interpretation The findings suggest the UN's accelerator approach for this high-risk adolescent population has policy and potential financing usefulness. Services that simultaneously promote several SDG targets, or combine to support particular targets, might be important to meet not only health-related targets, but also to ensure that adolescents in LMICs thrive within a new development framework. Funding Nuffield Foundation, UK Research and Innovation Global Challenges Research Fund, UKAID, Janssen Pharmaceutica, International AIDS Society, John Fell Fund, European Research Council, Economic and Social Research Council, Philip Leverhulme Trust, and UNICEF.
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Affiliation(s)
- Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - F Mark Orkin
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Medical Research Council Development Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Elona Toska
- Department of Sociology, University of Cape Town, Cape Town, South Africa; AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Douglas Webb
- HIV and Health Group, UN Development Programme, New York City, NY, USA
| | - Anna Carlqvist
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lorraine Sherr
- Department of Global Health, University College London, London, UK
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Adolescent HIV in Africa: linking local lives and global targets. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 3:203-204. [PMID: 30878108 DOI: 10.1016/s2352-4642(19)30060-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 11/23/2022]
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Pantelic M, Casale M, Cluver L, Toska E, Moshabela M. Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a South African cohort. J Int AIDS Soc 2020; 23:e25488. [PMID: 32438498 PMCID: PMC7242009 DOI: 10.1002/jia2.25488] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Efficacious antiretroviral treatment (ART) enables people to live long and healthy lives with HIV but young people are dying from AIDS-related causes more than ever before. Qualitative evidence suggest that various forms of HIV-related discrimination and resulting shame act as profound barriers to young people's engagement with HIV services. However, the impact of these risks on adolescent retention in HIV care has not been quantified. This study has two aims: (1) to examine whether and how different types of discrimination compromise retention in care among adolescents living with HIV in South Africa; and (2) to test whether internalized stigma mediates these relationships. METHODS Between 2014 and 2017, adolescents living with HIV (aged 10 to 19) from 53 health facilities in the Eastern Cape, South Africa, were interviewed at baseline (n = 1059) and 18-month follow-up (n = 979, 92.4%), with responses linked to medical records. Data were analysed through multiple regression and mediation models. RESULTS About 37.9% of adolescents reported full retention in care over the 2-year period, which was associated with reduced odds of viral failure (OR: 0.371; 95% CI: .224, .614). At baseline, 6.9% of adolescents reported discrimination due to their HIV status; 14.9% reported discrimination due to HIV in their families and 19.1% reported discrimination in healthcare settings. Healthcare discrimination was associated with reduced retention in care both directly (effect: -0.120; CI: -0.190, -0.049) and indirectly through heightened internalized stigma (effect: 0.329; 95% CI: 0.129, 0.531). Discrimination due to family HIV was associated with reduced retention in care both directly (effect: -0.074, CI: -0.146, -0.002) and indirectly through heightened internalized stigma (effect: 0.816, CI: 0.494, 1.140). Discrimination due to adolescent HIV was associated with reduced retention in care only indirectly, through increased internalized stigma (effect: 0.408; CI: 0.102, 0.715). CONCLUSIONS Less than half of adolescents reported 2-year retention in HIV care. Multiple forms of discrimination and the resultant internalized stigma contributed to this problem. More intervention research is urgently needed to design and test adolescent-centred interventions so that young people living with HIV can live long and healthy lives in the era of efficacious anti-retroviral treatment.
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Affiliation(s)
- Marija Pantelic
- University of SussexBrighton and Sussex Medical SchoolBrightonUK
- University of OxfordDepartment of Social Policy and InterventionOxfordUK
| | - Marisa Casale
- University of OxfordDepartment of Social Policy and InterventionOxfordUK
- University of the Western CapeSchool of Public HealthCape TownSouth Africa
| | - Lucie Cluver
- University of OxfordDepartment of Social Policy and InterventionOxfordUK
- University of Cape TownDepartment of Psychiatry and Mental HealthCape TownSouth Africa
| | - Elona Toska
- University of OxfordDepartment of Social Policy and InterventionOxfordUK
- University of Cape TownDepartment of SociologyCape TownSouth Africa
- University of Cape Town Centre for Social Science ResearchCape TownSouth Africa
| | - Mosa Moshabela
- University of KwaZulu‐NatalHoward CollegeSchool of Nursing and Public HealthDurbanSouth Africa
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Toska E, Campeau L, Cluver L, Orkin FM, Berezin MN, Sherr L, Laurenzi CA, Bachman G. Consistent Provisions Mitigate Exposure to Sexual Risk and HIV Among Young Adolescents in South Africa. AIDS Behav 2020; 24:903-913. [PMID: 31748938 PMCID: PMC7018679 DOI: 10.1007/s10461-019-02735-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Exposure to sexual risk in early adolescence strongly predicts HIV infection, yet evidence for prevention in young adolescents is limited. We pooled data from two longitudinal South African surveys, with adolescents unexposed to sexual risk at baseline (n = 3662). Multivariable logistic regression tested associations between intermittent/consistent access to eight provisions and reduced sexual risk exposure. Participants were on average 12.8 years, 56% female at baseline. Between baseline and follow-up, 8.6% reported sexual risk exposure. Consistent access to caregiver supervision (OR 0.53 95%CI 0.35-0.80 p = 0.002), abuse-free homes (OR 0.55 95%CI 0.37-0.81 p = 0.002), school feeding (OR 0.55 95%CI 0.35-0.88 p = 0.012), and HIV prevention knowledge (OR 0.43, 95%CI 0.21-0.88 p = 0.021) was strongly associated with preventing early sexual risk exposure. While individual factors reduced the odds of sexual risk exposure, a combination of all four resulted in a greater reduction, from 12.9% (95%CI 7.2-18.7) to 1.0% (95%CI 0.2-1.8). Consistent access to provisions in early adolescence may prevent sexual risk exposure among younger adolescents.
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Affiliation(s)
- Elona Toska
- AIDS and Society Research Unit, 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.
- University of Cape Town, 4.89 Leslie Social Science Building, 12 University Avenue South, Rondebosch, 7700, Cape Town, South Africa.
| | - Laurence Campeau
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, Cape Town, South Africa
| | - F Mark Orkin
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - McKenzie N Berezin
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Christina A Laurenzi
- Institute for Life Course Health Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Gretchen Bachman
- Office of HIV/AIDS, United States Agency for International Development, Arlington, VA, USA
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Cluver L, Pantelic M, Orkin M, Toska E, Medley S, Sherr L. Sustainable Survival for adolescents living with HIV: do SDG-aligned provisions reduce potential mortality risk? J Int AIDS Soc 2019; 21 Suppl 1. [PMID: 29485739 PMCID: PMC5978664 DOI: 10.1002/jia2.25056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/20/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction The Sustainable Development Goals (SDGs) present a groundbreaking global development agenda to protect the most vulnerable. Adolescents living with HIV in Sub‐Saharan Africa continue to experience extreme health vulnerabilities, but we know little about the impacts of SDG‐aligned provisions on their health. This study tests associations of provisions aligned with five SDGs with potential mortality risks. Methods Clinical and interview data were gathered from N = 1060 adolescents living with HIV in rural and urban South Africa in 2014 to 2015. All ART‐initiated adolescents from 53 government health facilities were identified, and traced in their communities to include those defaulting and lost‐to‐follow‐up. Potential mortality risk was assessed as either: viral suppression failure (1000+ copies/ml) using patient file records, or adolescent self‐report of diagnosed but untreated tuberculosis or symptomatic pulmonary tuberculosis. SDG‐aligned provisions were measured through adolescent interviews. Provisions aligned with SDGs 1&2 (no poverty and zero hunger) were operationalized as access to basic necessities, social protection and food security; An SDG 3‐aligned provision (ensure healthy lives) was having a healthy primary caregiver; An SDG 8‐aligned provision (employment for all) was employment of a household member; An SDG 16‐aligned provision (protection from violence) was protection from physical, sexual or emotional abuse. Research partners included the South African national government, UNICEF and Pediatric and Adolescent Treatment for Africa. Results 20.8% of adolescents living with HIV had potential mortality risk – i.e. viral suppression failure, symptomatic untreated TB, or both. All SDG‐aligned provisions were significantly associated with reduced potential mortality risk: SDG 1&2 (OR 0.599 CI 0.361 to 0.994); SDG 3 (OR 0.577 CI 0.411 to 0.808); SDG 8 (OR 0.602 CI 0.440 to 0.823) and SDG 16 (OR 0.686 CI 0.505 to 0.933). Access to multiple SDG‐aligned provisions showed a strongly graded reduction in potential mortality risk: Among adolescents living with HIV, potential mortality risk was 38.5% with access to no SDG‐aligned provisions, and 9.3% with access to all four. Conclusions SDG‐aligned provisions across a range of SDGs were associated with reduced potential mortality risk among adolescents living with HIV. Access to multiple provisions has the potential to substantially improve survival, suggesting the value of connecting and combining SDGs in our response to paediatric and adolescent HIV.
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Affiliation(s)
- Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Marija Pantelic
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.,International HIV/AIDS Alliance, Hove, United Kingdom
| | - Mark Orkin
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.,Development Pathways to Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.,AIDS and Society Research Unit, University of Cape Town, Cape Town, South Africa
| | - Sally Medley
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lorraine Sherr
- Department of Global Health, University College London, London, United Kingdom
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11
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Hodes R, Doubt J, Toska E, Vale B, Zungu N, Cluver L. The stuff that dreams are made of: HIV-positive adolescents' aspirations for development. J Int AIDS Soc 2019; 21 Suppl 1. [PMID: 29485764 PMCID: PMC5978641 DOI: 10.1002/jia2.25057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/11/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The Sustainable Development Goals (SDGs) commit to strengthening collaborations between governments and civil society. Adolescents are among the key target populations for global development initiatives, but research studies and programmes rarely include their direct perspectives on how to promote health and wellbeing. This article explores how both the methods and the findings of participatory research provide insights into adolescents' aspirations across the domains of health and social development. It investigates how adolescents conceive of health and social services as interconnected, and how this reflects the multisectoral objectives of the SDGs. METHODS This research was conducted within a longitudinal, mixed-methods study of HIV-positive adolescents (n = 80 qualitative participants, n = 1060 quantitative interviews). Between November 2013 and February 2014, a participatory exercise - the "dream clinic" - was piloted with 25 adolescents in South Africa's Eastern Cape. Key themes were identified based on the insights shared by participants, and through visual and thematic analysis. These findings were explored through a second participatory exercise, "Yummy or crummy? You are the Mzantsi Wakho masterchef !," conducted in January 2016. Findings are described in relation to emerging quantitative results. RESULTS Mixed methods explored associations between access to food, medicines, clean water and sanitation in HIV-positive adolescents' aspirations for development. The exercises produced practicable recommendations for innovations in development, based on associations between healthcare, food security, clean water and sanitation, while illustrating the value of partnership and collaboration (the objective of SDG17). Findings capture strong interlinkages between SDGs 2, 3 and 6 - confirming the importance of specific SDGs for HIV-positive adolescents. Study results informed the objectives of South Africa's National and Adolescent and Youth Health Policy (2017). CONCLUSIONS Participatory research may be used to leverage the perspectives and experiences of adolescents. The methods described here provide potential for co-design and implementation of developmental initiatives to fulfil the ambitious mandate of the SDGs. They may also create new opportunities to strengthen the engagement of adolescents in policy and programming.
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Affiliation(s)
- Rebecca Hodes
- AIDS and Society Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jenny Doubt
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Elona Toska
- AIDS and Society Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Beth Vale
- Mapungubwe Institute for Strategic Reflection, Johannesburg, South Africa
| | | | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Casale M, Carlqvist A, Cluver L. Recent Interventions to Improve Retention in HIV Care and Adherence to Antiretroviral Treatment Among Adolescents and Youth: A Systematic Review. AIDS Patient Care STDS 2019; 33:237-252. [PMID: 31166783 PMCID: PMC6588099 DOI: 10.1089/apc.2018.0320] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adolescents represent a growing proportion of people living with HIV worldwide and the highest risk population group for treatment attrition and AIDS-related mortality. There is an urgent need to design, implement, and test interventions that keep young people in HIV treatment and care. However, previous systematic reviews show scarce and inconclusive evidence of effective interventions for this age group. Recent years have seen an increase in focus on adolescent health and a rapidly changing programmatic environment. This systematic review article provides an evidence update by synthesizing empirical evaluations of interventions designed to improve antiretroviral therapy adherence and retention among adolescents (10-19) and youth (15-24) living with HIV, published between January 2016 and June 2018. A search of 11 health and humanities databases generated 2425 citations and 10 relevant studies, the large majority conducted in sub-Saharan Africa. These include six clinic-level interventions, one individual-level m-Health trial, and three community- or household-level interventions. Implications of their findings for future programming and research with young adults are discussed, in relation to previous reviews and the broader empirical evidence in this area. Findings highlight the need to further develop and test multi-faceted interventions that go beyond health facilities, to address broader social barriers to adherence and retention. In particular, further intervention studies with adolescents (10-19) should be a priority, if we are to retain these young people in treatment and care and aspire to achieve the United Nation's Sustainable Development Goals and 90-90-90 targets.
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Affiliation(s)
- Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anna Carlqvist
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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13
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Webb D, Cluver L, Luo C. Evolution or extinction? Paediatric and adolescent HIV responses in the Agenda 2030 era. J Int AIDS Soc 2018; 21 Suppl 1. [PMID: 29485744 PMCID: PMC5978653 DOI: 10.1002/jia2.25071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/18/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Douglas Webb
- HIV, Health and Development Group, United Nations Development Programme (UNDP), New York, NY, USA
| | - Lucie Cluver
- Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Chewe Luo
- HIV Section, Programme Division, United Nations Fund for Children (UNICEF), New York, NY, USA
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