1
|
Musanje K, Kasujja R, Camlin CS, Hooper N, Hope-Bell J, Sinclair DL, Kibanja GM, Mpirirwe R, Kalyango JN, Kamya MR. Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial. PLoS One 2024; 19:e0301988. [PMID: 38722926 PMCID: PMC11081388 DOI: 10.1371/journal.pone.0301988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/20/2024] [Indexed: 05/13/2024] Open
Abstract
Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.
Collapse
Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- School of Psychology, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- School of Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, United States of America
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, United Kingdom
| | - Josh Hope-Bell
- School of Medicine, Cardiff University, Wales, United Kingdom
| | | | | | - Ruth Mpirirwe
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Joan N. Kalyango
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University, Kampala, Uganda
| |
Collapse
|
2
|
Koay WLA, Aware Y, Andine T, Cruz Figueroa GM, Selekman RE, Bryant Y, Rakhmanina NY. Patient Perspectives on Telehealth for HIV and Mental Health Care at a Pediatric and Adolescent HIV Clinic in Washington, DC. AIDS Behav 2024; 28:993-1001. [PMID: 37843684 DOI: 10.1007/s10461-023-04209-7] [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: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Despite the scale-up of telehealth for children and youth living with HIV during the COVID-19 pandemic, their experience and interest in continued telehealth use in the future is unknown. We conducted a quality improvement project to identify areas for improvement of telehealth delivery to children and youth living with HIV and evaluate youth's experiences when using telehealth for mental health services. Children and youth living with HIV (up to 24 years) seen at a specialty HIV program during 2020-2021 were surveyed regarding technology access, telehealth knowledge, barriers to telehealth use and interest in future telehealth use for HIV care. Youth (12-<24 years) who used telehealth for mental health services were surveyed regarding their experiences. Data were analyzed using descriptive statistics. Of the 170 patients in care, we surveyed 103 children and youth living with HIV (median age 17.6 years, 88.3% Black, 52.4% female, 77.7% perinatally infected), of whom 69.9% had prior telehealth use for their clinical visit. Most patients had access to a device with internet (99%) and were interested in future telehealth use for HIV care (87.4%). Reasons for not wanting to use telehealth included privacy concerns, distrust, discomfort with telehealth, preferring in-person visits, technology access issues and needing translation services. Most youth (81%) surveyed regarding telehealth for mental health services were satisfied and very likely to recommend it to others. Despite some reported barriers to telehealth, there is a high desirability for continued telehealth use among children and youth receiving HIV care.
Collapse
Affiliation(s)
- Wei Li Adeline Koay
- Department of Pediatrics, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA.
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
| | - Yashvi Aware
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Tsion Andine
- College of Medicine, Howard University, Washington, DC, USA
| | | | - Rachel E Selekman
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | | | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Elizabeth Glaser Pediatrics AIDS Foundation, Washington, DC, USA
| |
Collapse
|
3
|
Cluver LD, Shenderovich Y, Seslija M, Zhou S, Toska E, Armstrong A, Gulaid LA, Ameyan W, Cassolato M, Kuo CC, Laurenzi C, Sherr L. Identifying Adolescents at Highest Risk of ART Non-adherence, Using the World Health Organization-Endorsed HEADSS and HEADSS+ Checklists. AIDS Behav 2024; 28:141-153. [PMID: 37589806 PMCID: PMC10803572 DOI: 10.1007/s10461-023-04137-6] [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: 07/11/2023] [Indexed: 08/18/2023]
Abstract
Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO's HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities. We used least absolute shrinkage and selection operator variable selection approach with a generalized linear mixed model. HEADSS constructs most predictive were: violence exposure (aOR 1.97, CI 1.61; 2.42, p < 0.001), depression (aOR 1.71, CI 1.42; 2.07, p < 0.001) and being sexually active (aOR 1.80, CI 1.41; 2.28, p < 0.001). Risk of non-adherence rose from 20.4% with none, to 55.6% with all three. HEADSS+ constructs were: medication side effects (aOR 2.27, CI 1.82; 2.81, p < 0.001), low social support (aOR 1.97, CI 1.60; 2.43, p < 0.001) and non-disclosure to parents (aOR 2.53, CI 1.91; 3.53, p < 0.001). Risk of non-adherence rose from 21.6% with none, to 71.8% with all three. Screening within established checklists can improve identification of adolescents needing increased support. Adolescent HIV services need to include side-effect management, violence prevention, mental health and sexual and reproductive health.
Collapse
Affiliation(s)
- Lucie D Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Yulia Shenderovich
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Marko Seslija
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Alice Armstrong
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Laurie A Gulaid
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | | | - Caroline C Kuo
- Department of Health Studies, American University, Washington, DC, USA
| | - Christina Laurenzi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Health Psychology Unit, Institute of Global Health, University College London, London, UK
| |
Collapse
|
4
|
Msefula MC, Umar E. Correlates of Depression in ART Adherence among Youths in Lilongwe, Malawi. Trop Med Infect Dis 2023; 9:2. [PMID: 38276632 PMCID: PMC10818860 DOI: 10.3390/tropicalmed9010002] [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: 08/29/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
Despite collaborative efforts to improve mental health services among youths living with HIV (YLHIVs) aged 15-24, evidence shows that many suffer from depression. We established the correlates of depression and how it affects ART adherence. Structured questionnaires, a Patient Health Questionnaire 9 depression scale assessment, in-depth interviews, and Electronic Medical Record reviews were conducted at the Lighthouse Trust Martin Preus Centre (MPC) ART clinic in Lilongwe from April 2021 to October 2022. A total of 303 YLHIVs aged 15-24 were on ART, and 7 key informants were recruited. Bivariate and multivariate logistic regression analyses were performed using STATA V14.1. A thematic content analysis was used for qualitative data. Forty-six per cent of recruits were male, and fifty-four per cent were female. Seventy-one per cent were aged 20-24, and twenty-nine per cent were aged 15-19. Twenty-three per cent of the YLHIVs had depression symptoms, of whom seventy-nine per cent were aged 20-24 years. Twenty-two per cent had an unsuppressed viral load (non-adherent). Sixty-seven per cent of non-adherent participants were aged 20-24. There was no factor associated with ART non-adherence. Source of income (p = 0.003), alcohol consumption (p = 0.010), and sexual behaviour (p = 0.014) were associated with depression. Sexual behaviour was statistically significantly associated with depression (p = 0.024. The themes were a lack of basic needs, a lack of privacy, psychological trauma, incomplete disclosure, a shortage of psychosocial providers, and a knowledge deficit of ART providers to screen for depression. This study shows that depression is considerably high among YLHIVs in Malawi and linked to ART non-adherence. Strengthening mental health training for providers and routinely screening YLHIVs for depression would help in the early identification and management of depression, thereby improving ART adherence.
Collapse
Affiliation(s)
- Mary Carolyne Msefula
- Department of Health Sciences, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre P.O. Box 360, Malawi;
- Lighthouse Trust Malawi, Lilongwe P.O. Box 106, Malawi
| | - Eric Umar
- Department of Health Sciences, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre P.O. Box 360, Malawi;
| |
Collapse
|
5
|
Laurenzi C, Operario D, Mutambo C, Mupakile E, Banda B, Ngakongwa F, Kilonzo R, Busakhwe C, Ronan A, Toska E. Lessons From Implementing Ask-Boost-Connect-Discuss, a Peer-Delivered Psychosocial Intervention for Young Mothers Living With HIV in Malawi, Tanzania, Uganda, and Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300077. [PMID: 37903574 PMCID: PMC10615246 DOI: 10.9745/ghsp-d-23-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
Adolescent girls and young women in sub-Saharan Africa are at high risk of HIV, unintended pregnancy, and early motherhood. These intersecting risks can adversely affect their developmental trajectories and lifelong well-being. Because young mothers living with HIV in these settings experience high levels of stigma, shame, and isolation, tailored psychosocial intervention approaches for this group are critical yet unavailable. Enlisting young peer supporters may be a promising way to expand the reach of health services and enhance psychosocial well-being. To date, few peer-based interventions have targeted young mothers living with HIV. In 2019-2021, we codeveloped a peer-based, facility-embedded intervention package, Ask-Boost-Connect-Discuss (ABCD), with young peer supporters to address the psychosocial needs of young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia. We then analyzed programmatic data from ABCD to assess the feasibility of using young peers to deliver psychosocial support. Data sources included post-intervention interviews, focus groups, and written feedback from multiple stakeholders (participants, peer supporters, their supervisors, and clinic-based mentors), which were analyzed thematically. We organized our findings according to Bowen et al.'s feasibility framework. Findings spoke to the acceptability, practicality, and integration of the ABCD program. We found that young peer supporters were seen as acceptable program implementers; able to adopt responsive, engaging, and nonjudgmental approaches; and supported through training, technical skills development, and supervision, alongside purposeful facility integration. Importantly, we also found evidence reflecting the roles of demand and adaptation in program delivery (i.e., how peers responded to emerging participant needs or pivoted in their approach based on shifting circumstances). We conclude that considerations of intervention feasibility and/or program fidelity should be attuned to the dynamic qualities of young peer supporters as implementers and should extend beyond standard modes of assessment to consider intervention codevelopment and implementation as an iterative and adaptive process.
Collapse
Affiliation(s)
- Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chipo Mutambo
- Paediatric-Adolescent Treatment Africa, Cape Town, South Africa
| | | | | | | | | | - Chuma Busakhwe
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Agnes Ronan
- Paediatric-Adolescent Treatment Africa, Cape Town, South Africa
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom
| |
Collapse
|
6
|
Orth Z, van Wyk B. Content validation of a mental wellness measuring instrument for adolescents living with HIV: a modified delphi study. BMC Psychol 2023; 11:339. [PMID: 37849013 PMCID: PMC10583403 DOI: 10.1186/s40359-023-01350-9] [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: 01/18/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
A growing body of evidence suggests that improving the mental wellness of adolescents living with HIV (ALHIV) will also result in improved adherence to antiretroviral therapy (ART), as well as improving their general health and wellbeing as they age into adulthood. However, to develop effective strategies and interventions aimed at improving mental wellness, we require age and culturally appropriate instruments to build an evidence base. Currently, there is a lack of mental wellness measures developed for ALHIV, especially in the African context. To address this gap, we developed a measure of mental wellness following modified guidelines set out by DeVellis [1] and Godfred et al. as a guiding framework [2]; (1) Identifying the gap, (2) Set the theoretical foundations and identify domains and (3); Instrument development and initial validation. For the first two steps, we conducted a systematic review, photovoice study and integrative review - which we briefly describe as the findings have been published. Following this we describe the processes to develop the instrument and to establish content validity through a modified Delphi Study. Through this process we were able to refine the instrument which will be subject to further testing.Implications and Contribution: This study aims to add to the body of knowledge on promoting mental health (mental wellness) among adolescents living with HIV in South Africa through developing an appropriate and valid measure of mental wellness for this population. This study reports on the results of a Delphi Study aimed at improving the content validity of the instrument Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV).
Collapse
Affiliation(s)
- Zaida Orth
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape Robert Sobukwe Rd, 7535, Bellville, South Africa.
| | - Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape Robert Sobukwe Rd, 7535, Bellville, South Africa
| |
Collapse
|
7
|
Altamirano J, Odero IA, Omollo M, Awuonda E, Ondeng’e K, Kang JL, Behl R, Ndivo R, Baiocchi M, Barsosio HC, Sarnquist CC. Understanding ART Adherence among Adolescent Girls and Young Women in Western Kenya: A Cross-Sectional Study of Barriers and Facilitators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6922. [PMID: 37887660 PMCID: PMC10606388 DOI: 10.3390/ijerph20206922] [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: 08/02/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND HIV remains a leading cause of death for adolescent girls and young women (AGYW) in sub-Saharan Africa. This population has a high incidence of HIV and other comorbidities, such as experiencing violence, and low antiretroviral therapy (ART) adherence. To reach global HIV goals, data are needed on the specific adherence barriers for AGYW living with HIV, so interventions can be targeted effectively. METHODS Cross-sectional data were collected at urban and rural health facilities in and around Kisumu County, western Kenya, from January to June 2022, from AGYW 15-24 years of age who were living with HIV. Surveys included questions on intimate partner violence, mental health issues, food security, and orphanhood. Adherence was categorized using viral load testing where available and the Center for Adherence Support Evaluation (CASE) adherence index otherwise. Logistic regression was used to assess associations between potential explanatory variables and adherence. FINDINGS In total, 309 AGYW participated. AGYW with experiences of emotional violence (Odds Ratio [OR] = 1.94, 95% Confidence Interval [CI] = 1.03-3.66), moderate or severe depression (OR = 3.19, 95% CI = 1.47-6.94), and/or substance use (OR = 2.71, 95% CI = 1.24-5.92) had significantly higher odds of poor adherence when compared to AGYW without these respective experiences. Physical and sexual violence, food insecurity, and orphanhood were not associated with poor adherence in this cohort. INTERPRETATION Elucidating the risk factors associated with poor adherence among AGYW living with HIV allows us to identify potential targets for future interventions to improve ART adherence and HIV care outcomes. Mental health and violence prevention interventions, including combination interventions, may prove to be promising approaches.
Collapse
Affiliation(s)
- Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Isdorah A. Odero
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Mevis Omollo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Eucabeth Awuonda
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Ken Ondeng’e
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Jennifer L. Kang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| | - Rasika Behl
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| | - Richard Ndivo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Hellen C. Barsosio
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Clea C. Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| |
Collapse
|
8
|
Bernays S, Lariat J, Cowan F, Senzanje B, Willis N, Nenguke ZM. "They test my blood to know how much blood is in my body": the untapped potential of promoting viral load literacy to support adherence and viral suppression among adolescents living with HIV. J Int AIDS Soc 2023; 26:e26153. [PMID: 37880186 PMCID: PMC10600064 DOI: 10.1002/jia2.26153] [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: 01/18/2023] [Accepted: 08/16/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Achieving sustained HIV viral suppression is a key strategy to optimize the health and wellbeing of those living with HIV. Sub-optimal adherence to antiretroviral therapy (ART) in adolescents and young people living with HIV (AYPLHIV) in Southern Africa, due to a range of social and contextual factors, including poor mental health, has presented a substantial challenge to meeting targets aimed towards improving treatment outcomes and reducing transmission. With the increasing availability of viral load (VL) testing in Southern Africa, there is an opportunity to better understand the relationship between VL literacy, wellbeing and adherence among adolescents. METHODS We conducted qualitative interviews with 45 AYPLHIV aged 10-24 years in three districts (urban, peri-urban and rural) in Zimbabwe between March and August 2021. The sample was purposively selected to represent a range of experiences related to HIV status disclosure, gender, marital status and treatment experience. Separate workshops were conducted with 18 healthcare workers (HCWs) and 20 caregivers to better understand existing support mechanisms to AYPLHIV accessing ART. We used thematic analysis to examine adolescent VL literacy, treatment support networks, experiences of clinic interactions, VL testing procedures and barriers to adherence. RESULTS VL literacy was consistently under-developed among participants. Comprehension of phrases commonly heard during clinic visits, such as TND (target not detected) and "high" and "low" VL, were better understood by older participants. VL testing was predominantly understood as a clinical procedure that enables HCWs to monitor treatment adherence. Absent throughout the interviews were descriptions of how viral suppression improves health and quality of life, likely fosters wellbeing and enhances self-esteem, enables participation in education and social activities, and eliminates the risk of onward transmission. CONCLUSIONS It is imperative that we reconsider how routine VL monitoring is communicated to and understood by AYPLHIV. Reframing ART, including VL test results, in terms of the psychosocial benefits that viral suppression can generate is likely to be crucial to motivating AYPLHIV to maintain optimal treatment engagement and develop self-management approaches as they move into adulthood. Access to accurate information tailored to individual concerns and circumstances can support AYPLHIV to achieve wellbeing.
Collapse
Affiliation(s)
- Sarah Bernays
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
- Department of Global Health and Development London School of Hygiene & Tropical MedicineLondonUK
| | - Joni Lariat
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
| | | | | | | | | |
Collapse
|
9
|
Muyinda H, Jongbloed K, Zamar DS, Malamba SS, Ogwang MD, Katamba A, Oneka A, Atim S, Odongpiny TO, Sewankambo NK, Schechter MT, Spittal PM. Cango Lyec (Healing the Elephant): HIV Prevalence and Vulnerabilities Among Adolescent Girls and Young Women in Postconflict Northern Uganda. J Acquir Immune Defic Syndr 2023; 94:95-106. [PMID: 37276188 PMCID: PMC10497204 DOI: 10.1097/qai.0000000000003234] [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: 09/28/2022] [Accepted: 04/21/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Adolescent girls and young women younger than 25 years (AGYW) account for disproportionate HIV infections in sub-Saharan Africa. Impacts of war in Northern Uganda continue to affect HIV-related health and wellbeing of young people postconflict. Prevalence and incidence of HIV infection were estimated, and factors associated with HIV prevalence among sexually active AGYW in Northern Uganda were investigated. METHODS Cango Lyec is a cohort involving conflict-affected populations in Northern Uganda. Nine randomly selected communities in Gulu, Nwoya, and Amuru districts were mapped. House-to-house census was conducted. Consenting participants aged 13-49 years were enrolled over 3 study rounds (2011-2015), of whom 533 were AGYW and had ever had sex. Data were collected on trauma, depression, and sociodemographic-behavioral characteristics. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression determined baseline factors associated with HIV prevalence. RESULTS HIV prevalence among AGYW was 9.7% (95% CI: 7.3 to 12.6). AGYW living in Gulu (adjusted risk ratio, aRR: 2.48; 95% CI: 1.12 to 5.51) or Nwoya (aRR: 2.65; 95% CI: 1.03 to 6.83) were more likely than in Amuru to be living with HIV. Having self-reported genital ulcers (aRR: 1.93; 95% CI: 0.97 to 3.85) or active syphilis (aRR: 3.79; 95% CI: 2.35 to 6.12) was associated with increased risk of HIV infection. The likelihood of HIV was higher for those who experienced sexual violence in the context of war (aRR: 2.37; 95% CI: 1.21 to 4.62) and/or probable depression (aRR: 1.95; 95% CI: 1.08 to 3.54). HIV incidence was 8.9 per 1000 person-years. CONCLUSION Ongoing legacies of war, especially gender violence and trauma, contribute to HIV vulnerability among sexually active AGYW. Wholistic approaches integrating HIV prevention with culturally safe initiatives promoting sexual and mental health in Northern Uganda are essential.
Collapse
Affiliation(s)
- Herbert Muyinda
- Child Health Development Center, Makerere University, Kampala, Uganda
| | - Kate Jongbloed
- BC Office of the Provincial Health Officer, Victoria, Canada
| | - David S. Zamar
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| | | | | | - Achilles Katamba
- College of Health Sciences, Makerere University, Kampala, Uganda; and
| | | | | | | | | | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia M. Spittal
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| |
Collapse
|
10
|
Mayman YR, van Wyk B. The impact of COVID-19 on HIV treatment of adolescents in sub-Saharan Africa: A scoping review. Health SA 2023; 28:2226. [PMID: 37795154 PMCID: PMC10546235 DOI: 10.4102/hsag.v28i0.2226] [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: 10/26/2022] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Adolescents living with HIV are a key population who are susceptible to poor health. The global coronavirus disease 2019 pandemic and widespread national COVID-19 restrictions has disrupted health service delivery and HIV support services, affecting treatment adherence among adolescents with HIV. Aim This study aimed to review the available literature on the impact of the COVID-19 pandemic on the HIV treatment of adolescents in sub-Saharan Africa. Method Seven online databases were searched for articles published between 2020 and 2022 that focused on the impact of COVID-19 on adolescents living with HIV on antiretroviral therapy. A data charting extraction form and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA) flowchart were used for screening and reporting the articles in this review. A narrative synthesis was conducted. Results Five overarching themes emerged from the articles in this review, which highlighted the mental, social, and economic impacts of the COVID-19 pandemic, as well as the impact of the reallocation of healthcare services and challenges to accessing HIV care services on the antiretroviral therapy (ART) adherence of adolescents living with HIV. Conclusion The global COVID-19 pandemic affected adolescents living with HIV in sub-Saharan Africa in many ways, but very little research has been done to describe the various ways in which the physical and mental well-being of adolescents were impacted. Contribution The findings of this review can be used to further inform policies and interventions aimed at the care and well-being of adolescents on antiretroviral therapy within sub-Saharan Africa.
Collapse
Affiliation(s)
- Yolanda R Mayman
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
11
|
Sauceda JA, Dubé K, Harris O, Campbell CK, Ndukwe S, Saberi P. Brief Report: The Influence of the COVID-19 Pandemic on the Physical, Social, and Mental Health of Black and Latinx Young People With HIV in the United States. J Acquir Immune Defic Syndr 2023; 93:187-190. [PMID: 36913727 PMCID: PMC10272066 DOI: 10.1097/qai.0000000000003188] [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: 03/15/2023]
Abstract
BACKGROUND Whereas national attention has been paid to the ongoing mental health crises among young people triggered by the COVID-19 pandemic, less is known about the social, physical and psychological impacts of COVID-19 on young people living with HIV, especially racial/ethnic minorities. SETTING Online survey of participants across the U.S. METHOD A national cross-sectional survey of non-Latinx Black and Latinx young adults (18-29) living with HIV. Between April and August 2021, participants answered survey questions about several domains (eg, stress, anxiety, relationships, work, quality of life) that were worsened, improved, or unchanged during the pandemic. We ran a logistic regression estimating the self-reported impact of the pandemic on these domains between 2 age groups (ages 18-24 versus 25-29). RESULTS The sample size was 231 (186 non-Latinx Black, 45 Latinx) and mainly male (84.4%) and gay identified (62.2%). Nearly 20% of participants were 18-24 years old and 80% were ages 25-29. Participants who were 18-24 years old reported 2-3 times the odds for having worse sleep quality and mood and greater stress, anxiety, and weight gain compared with those 25-29 years old. CONCLUSION Our data provide a nuanced picture of the negative impacts that COVID-19 had on non-Latinx Black and Latinx young adults living with HIV in the U.S. Given that these adults represent a priority population for HIV treatment outcomes, it is critical to better understand the ongoing toll that these dual pandemics have on their lives.
Collapse
Affiliation(s)
- John A. Sauceda
- Division of Prevention Science; University of California, San Francisco; San Francisco, CA, USA
| | - Karine Dubé
- University of California San Diego School of Medicine Division of Infectious Diseases and Global Public Health, San Diego, CA USA
| | - Orlando Harris
- Division of Prevention Science; University of California, San Francisco; San Francisco, CA, USA
- Department of Community Health Systems; School of Nursing, University of California, San Francisco, San Francisco, CA
| | - Chadwick K. Campbell
- Herbert Wertheim School of Public Health & Human Longevity Science; University of California, San Diego
| | - Samuel Ndukwe
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Parya Saberi
- Division of Prevention Science; University of California, San Francisco; San Francisco, CA, USA
| |
Collapse
|
12
|
Abimiku A, Ramadhani HO, Moloney M, Stafford KA, Chang JCW, Patel HK, Domaoal RA, Okoye M, Jelpe T, Bronson M, Ibrahim D, Swaminathan M, Gambo A, Charurat M. Factors associated with viral suppression among adults living with HIV on antiretroviral therapy in Nigeria: Analysis of a population-based survey, 2018. HIV Med 2023; 24:827-837. [PMID: 36945183 PMCID: PMC11195444 DOI: 10.1111/hiv.13485] [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: 08/09/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Viral load suppression (VLS) is critical in reducing morbidity and mortality associated with HIV as well as minimizing the likelihood of HIV transmission to uninfected persons. The objective of this study was to identify factors associated with VLS among people living with HIV (PLWH) on antiretroviral (ARV) therapy to inform HIV programme strategies in Nigeria. METHODS Adult participants, aged 15-64 years, from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), who self-reported to be a PLWH or had detectable ARVs, were analysed to examine factors associated with VLS defined as HIV RNA <1000 copies/mL. NAIIS measured HIV prevalence, viral load, ARV and hepatitis B in PLWH. Logistic regression models were used and reported weighted prevalence. RESULTS Of 1322 participants, 949 (68.25%) were women and 1287 (96.82%) had detectable ARVs. The median age was 39.31 [interquartile range (IQR): 31.47-47.63] years. Prevalence of VLS was 80.88%. Compared with participants with detectable ARVs, those with undetectable ARVs in their blood specimens had lower odds of VLS [adjusted odds ratio (aOR) = 0.24, 95% confidence interval (CI): 0.08-0.64). Coinfection with hepatitis B and nonnucleoside reverse transcriptase inhibitor metabolites were also associated with lower odds of VLS. Older people (45-54 vs 15-24 years) had increased odds of VLS (aOR = 2.81, 95% CI: 1.14-6.90). CONCLUSION Young people and those with undetectable ARVs had lower odds of virological suppression. Targeted interventions focusing on young people and adherence to medication are needed to achieve the UNAIDS 95-95-95 goals for HIV epidemic control.
Collapse
Affiliation(s)
- Alash’le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mirna Moloney
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joy Chih-Wei Chang
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hetal K. Patel
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Robert A. Domaoal
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - McPaul Okoye
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Tapidiyel Jelpe
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Megan Bronson
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dalhatu Ibrahim
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Mahesh Swaminathan
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Aliyu Gambo
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
13
|
Nakimuli-Mpungu E, Wamala K, Nalugya JS, Nakanyike C, Iya J, Bakeera Kitaka S, Diana Namuli J, Akimana B, Nachega JB, Mills EJ, Seggane M. The effect of group support psychotherapy on adherence to anti-retroviral therapy and viral suppression among HIV positive young people: Study protocol for a pilot randomized controlled trial. FRONTIERS IN HEALTH SERVICES 2023; 3:1011898. [PMID: 37089453 PMCID: PMC10115161 DOI: 10.3389/frhs.2023.1011898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
BackgroundSeveral studies have demonstrated an association between psychological risk factors and HIV disease progression. However, there is limited information on the use of psychological interventions to improve HIV treatment outcomes in young people living with HIV.ObjectiveThis pilot trial aims to evaluate the feasibility, acceptability and preliminary effectiveness of group support psychotherapy in improving adherence to anti-retroviral therapy and viral suppression in young people living with HIV in Uganda.MethodsWe recruited 120 young people with HIV, aged 10–18 years, who had non-viral suppression 6 months after initiating first-line anti-retroviral therapy (ART) from community based HIV clinics in Kitgum district, northern Uganda. Participants were randomly assigned to receive GSP plus IAC (N = 60) or IAC alone (N = 60). Primary outcomes will be indicators of feasibility and acceptability as well as preliminary effectiveness of GSP in improving ART adherence and viral suppression analysed by intention to treat using cluster-adjusted t tests and permutation tests. Secondary outcomes will be measures of depression, anxiety and cost-effectiveness.ResultsThe trial has been approved by the Makerere College of Health Sciences School of Health Sciences Research Ethics Committee, and the Uganda National Council of Science and Technology. Recruitment began in June 2021 and 120 young people living with HIV with their adult caregivers have been recruited to the trial. An analysis of baseline and 6-month data is in progress. The results of this trial will not only be presented at national and international conferences but also submitted for publication in peer-reviewed journals and as a report to the funding agencies.ConclusionsThis pilot trial will provide critical evidence to support the ongoing mental health integration into routine HIV care in Uganda.Trial RegistrationPan African Clinical Trials Registry (PACTR): 202006601935462
Collapse
Affiliation(s)
- Etheldreda Nakimuli-Mpungu
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Paediatrics and Childhealth, MakCHS, SEEK Group Support Psychotherapy Initiative Limited, Kampala, Uganda
- Correspondence: Etheldreda Nakimuli-Mpungu
| | - Kizito Wamala
- Department of Psychology, Center for Victims of Torture, Gulu, Uganda
| | | | - Caroline Nakanyike
- Department of Paediatrics and Childhealth, MakCHS, SEEK Group Support Psychotherapy Initiative Limited, Kampala, Uganda
| | - Jane Iya
- Department of Paediatrics and Childhealth, MakCHS, SEEK Group Support Psychotherapy Initiative Limited, Kampala, Uganda
| | - Sabrina Bakeera Kitaka
- Department of Pediatrics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justine Diana Namuli
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Benedict Akimana
- Butabika National Referral Mental Hospital, Ministry of Health of Uganda, Kampala, Uganda
| | - Jean B. Nachega
- Departments of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
- Center for Infectious Disease, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Departments of International Health and Epidemiology, Bloomberg’s School of Public Health, Johns Hopkins University, Kampala, Uganda
| | - Edward J. Mills
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Musisi Seggane
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
14
|
Orth Z, Van Wyk B. Asking the Experts: Using Cognitive Interview Techniques to Explore the Face Validity of the Mental Wellness Measure for Adolescents Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4061. [PMID: 36901066 PMCID: PMC10001944 DOI: 10.3390/ijerph20054061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
There has been an increased focus on the mental health of adolescents living with HIV (ALHIV), because evidence shows that poor mental health outcomes are associated with lower rates of adherence and retention in HIV care. However, the research to date has predominantly focused on addressing mental health problems and reducing symptoms of mental illness rather than strengthening mental wellness [positive mental health]. Consequently, little is known about the critical mental wellness indicators that should be targeted in services for ALHIV. There is a need for valid and appropriate measures of mental wellness to drive research and provide evidence on the mental wellness needs of ALHIV that would inform service delivery as well as the monitoring and evaluation of treatment outcomes. To this end, we developed the Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV) for ALHIV in the South African context. In this paper, we report on the findings from a cognitive interview study with nine ALHIV aged 15-19 years receiving treatment at a public healthcare facility in the Cape Metropole, South Africa. Through interviews, participants identified key issues related to the wording, relevance and understanding of the items and provided suggestions to improve the instrument's overall face validity.
Collapse
|
15
|
Crowley T, Petinger C, Nchendia AI, van Wyk B. Effectiveness, Acceptability and Feasibility of Technology-Enabled Health Interventions for Adolescents Living with HIV in Low- and Middle-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2464. [PMID: 36767831 PMCID: PMC9916219 DOI: 10.3390/ijerph20032464] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adolescents living with HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology-enabled interventions can be used to optimize healthcare delivery to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa. This review synthesized the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). METHODS Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar were searched to identify studies in LMIC published from 2010 to 2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10-19 years) were included. The review was performed, and findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols. The review was registered with PROSPERO: CRD42022336330. RESULTS There is weak evidence that technology-enabled health interventions for ALHIV in LMIC improve treatment outcomes. However, most interventions appear to be acceptable and feasible. CONCLUSION There is a need to ensure that technology-enabled interventions have a strong theoretical base. Larger studies with rigorous evaluation designs are needed to determine the effects of these interventions on the health outcomes of ALHIV in LMIC.
Collapse
Affiliation(s)
- Talitha Crowley
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| | - Charné Petinger
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| | - Azia Ivo Nchendia
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| | - Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| |
Collapse
|
16
|
Mental Health Problems Across the HIV Care Continuum for Adolescents Living with HIV in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2023:10.1007/s10461-023-03981-w. [PMID: 36650389 PMCID: PMC10350473 DOI: 10.1007/s10461-023-03981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
Mental health problems (e.g., anxiety, depression) are frequently experienced by adolescents living with HIV (ALWH) and can worsen HIV-related outcomes. This scoping review synthesizes the existing research on ALWHs' mental health problems at multiple steps along the HIV care continuum in sub-Saharan Africa. Searching PubMed, CINAHL, EMBASE, and PsycINFO identified 34 peer-reviewed studies that met inclusion criteria. Most studies assessed ALWHs' mental health problems at the "Engaged or Retained in Care" continuum step, are cross-sectional, focus on depression and anxiety, and used measures developed in high-income countries. Studies identify mental health problems among ALWH as prevalent and barriers to care. Significant gaps remain in understanding how mental health problems and their relationships with HIV-related health outcomes shift across the continuum. Additional attention is needed, especially at the HIV testing and viral suppression steps, to generate a more comprehensive understanding of mental health needs and priority timepoints for intervention for ALWH.
Collapse
|
17
|
Gittings L, Colvin C, Hodes R. Traditional and biomedical health practices of adolescent boys and young men living with perinatally-acquired HIV in the Eastern Cape Province of South Africa. Glob Public Health 2023; 18:2205917. [PMID: 37156226 PMCID: PMC10660542 DOI: 10.1080/17441692.2023.2205917] [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: 06/30/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
Men are less vulnerable to HIV acquisition than women, but have poorer HIV-related health outcomes. They access HIV services less, and are more likely to die on antiretroviral therapy. The adolescent epidemic presents further challenges, and AIDS-related illness is the leading cause of death among adolescents in sub-Saharan Africa. We explored the health practices of adolescent boys and young men (aged 13-22) living with perinatally-acquired HIV and the processes through which these practices are formed and sustained. We engaged health-focused life history narratives (n = 35), semi-structured interviews (n = 32) and analysis of health facility files (n = 41), alongside semi-structured interviews with traditional and biomedical health practitioners (n = 14) in the Eastern Cape, South Africa. Participants did not access traditional products and services for HIV, a finding that deviates from much of the literature. Findings suggest that health practices are mediated not only by gender and culture, but also childhood experiences of growing up deeply embedded in the biomedical health system.
Collapse
Affiliation(s)
- Lesley Gittings
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Christopher Colvin
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Rebecca Hodes
- Centre for Sexualities, AIDS & Gender, University of Pretoria, Pretoria, South Africa
- Department of Historical and Heritage Studies, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
18
|
Laurenzi C, Ronan A, Phillips L, Nalugo S, Mupakile E, Operario D, Toska E. Enhancing a peer supporter intervention for young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia: Adaptation and co-development of a psychosocial component. Glob Public Health 2023; 18:2081711. [PMID: 35634944 PMCID: PMC9705607 DOI: 10.1080/17441692.2022.2081711] [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: 09/13/2021] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
ABSTRACTYoung mothers living with HIV (YMHIV) experience heightened risks to their mental health, as their transition to adulthood is marked by social stigma, health and socioeconomic challenges. Targeted psychosocial interventions may improve the mental health of YMHIV; however, no evidence-based interventions have been developed for this group. Peer support models, more common for youth living with HIV, show promise as a design to reach YMHIV in a non-stigmatising way. This manuscript describes the process of adapting and co-developing an evidence-based psychosocial component (Boost) of a larger intervention called Ask-Boost-Connect-Discuss. Peer supporters in Malawi, Tanzania, Uganda, and Zambia used ABCD to guide group sessions with YMHIV. The research team partnered with an implementing partner, Paediatric-Adolescent Treatment Africa, to undertake this work in three phases: 1) formative research, 2) content adaptation and development, and 3) consultation, refinement, and modification. YMHIV (n = 4), peer supporters (n = 21), and technical advisors (n = 4) were engaged as co-developers, shaping the resulting Boost intervention component at each phase. Peer support models may effectively reach young mothers, and consultation, co-creation, and integration with existing programming can offer rich insights to inform these models. We discuss the implications and promise of this approach.
Collapse
Affiliation(s)
- Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Agnes Ronan
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Lynn Phillips
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Sharifah Nalugo
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Eugene Mupakile
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Don Operario
- Department of Behavior and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - 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
| |
Collapse
|
19
|
Chingono R, Kasese C, Miles S, Busza J. 'I was in need of somewhere to release my hurt:' Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups. Glob Health Action 2022; 15:2040151. [PMID: 35322767 PMCID: PMC8956306 DOI: 10.1080/16549716.2022.2040151] [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] [Indexed: 11/29/2022] Open
Abstract
Background Adolescents experiencing multiple vulnerabilities, including poverty, curtailed education, transactional sex and early childbearing, are at risk of poor mental health. In Zimbabwe, girls who are pregnant or new mothers and involved in selling sex struggle to cope with the combined pressures of parenthood, financial insecurity, and social stigma. A pilot intervention brought such girls together into self-help groups to increase peer support, resources and skills. Objective This study aimed to explore whether and how participation in a self-help group intervention affected vulnerable young mothers’ experiences and perceptions of mental health stressors. Methods Self-help groups received 12 participatory sessions over 6 months. Eighteen semi-structured interviews and three focus group discussions were held with participants and drop-outs. Before and after the intervention, participants completed the locally validated 14-item Shona Symptom Questionnaire tool to indicate the probable prevalence of common mental health disorders. Results Adolescent girls described mutually reinforcing stressors in their lives and reported low self-esteem and anxiety. Key themes emerging from qualitative data centred around girls’ struggles with adverse life events, the burden of new motherhood, social isolation related to sex work and self-help groups as a source of hope. Participants joined groups to obtain support and felt their mental well-being improved due to new social networks, feelings of solidarity with peers, and increased confidence for positive action, that is, seeking health services for themselves and their babies. Prior to enrolment 16% showed signs of possible common mental disorders falling to 2% at follow-up. Conclusions Participants believed involvement in interactive self-help groups improved their mental health by strengthening peer support and engendering hope for the future. Although reduced mental distress cannot be attributed to the programme, the pilot intervention offers a low-cost approach that could be rigorously tested and adapted to a wide range of community settings.
Collapse
Affiliation(s)
- Rudo Chingono
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Institute of Global Health, University College London, UK
| | - Constance Kasese
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Sam Miles
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
20
|
Orth Z, Van Wyk B. Rethinking mental health wellness among adolescents living with HIV in the African context: An integrative review of mental wellness components. Front Psychol 2022; 13:955869. [PMID: 36204730 PMCID: PMC9530459 DOI: 10.3389/fpsyg.2022.955869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Adolescents living with HIV (ALHIV) are considered to be at heightened risk for developing mental health problems in comparison to their peers due to the burden of living with a stigmatized condition and managing a chronic condition. Poorer mental health outcomes among ALHIV are associated with lower rates of adherence to anti-retroviral therapy (ART). It is necessary to improve mental wellness among ALHIV as this acts as a buffer against developing mental health problems which, if left untreated can evolve into mental health disorders. Research on mental wellness concepts among ALHIV is underdeveloped which is associated with a lack of appropriate measures of mental wellness. We conducted an integrative review to conceptualize mental wellness and consider the critical components for measuring mental wellness in ALHIV. Method An integrative review of published literature focusing on mental wellness of ALHIV in the African context was conducted. The process was guided by the PRISMA operational steps. As part of our problem identification phase, we drew on findings from a previous systematic review of mental wellness instruments and a qualitative photovoice study on exploring the experiences of ALHIV, to develop an initial framework of 13 mental wellness concepts and behaviors which informed the search strategy. Results The review included 17 articles from which we identified six mental wellness concepts: Connectedness, Sense of Coherence (SOC), Self-esteem, Self-acceptance, Hope for the Future and Spirituality as well as six behaviors facilitating mental wellness: Coping, Resilience, Purpose in Life (goals), Self-efficacy, Adherence Self-efficacy, and Leisure Activities. All of these concepts and behaviors have been noted in our previous research (systematic review and qualitative work), with the exception of adherence self-efficacy. Based on the findings from this review and our previous work, we adapted the Salutogenic Model of Health developed by Antonovsky in 1987, to propose a Salutogenic Model of Mental Wellness (SMoMW) for ALHIV in the African context. This SMoMW may be used to develop an age and culturally appropriate measure of mental wellness for ALHIV. Conclusion The findings from this review used to conceptualize mental wellness among ALHIV which can be used to develop a measurement of mental wellness.
Collapse
Affiliation(s)
- Zaida Orth
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | |
Collapse
|
21
|
Revegue MHDT, Jesson J, Dago-Akribi HA, Dahourou D, Ogbo P, Moh C, Amoussou-Bouah U, N’Gbeche MS, Eboua FT, Kouassi EM, Kouadio K, Cacou MC, Horo A, Msellati P, Sturm G, Leroy V. [Sexual and reproductive health of adolescents living with HIV in pediatric care programs in Abidjan : Structured provision of care and perceptions of health care workers in 2019]. Rev Epidemiol Sante Publique 2022; 70:163-176. [PMID: 35752510 PMCID: PMC9926011 DOI: 10.1016/j.respe.2022.04.003] [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: 03/07/2021] [Revised: 03/31/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The majority of adolescents living with HIV (ALHIV) reside in sub-Saharan Africa, with sexual and reproductive health (SRH) needs to be met. The health care facilities and professionals involved have a major role to assume in the quality of SRH services offered to these teenagers. OBJECTIVE To investigate the SRH services offered to ALHIV subjects in pediatric facilities in Abidjan, Ivory-Coast. METHODS In 2019 we conducted an exploratory cross-sectional study using qualitative and quantitative methods in three pediatric facilities caring for ALHIV subjects (CIRBA, CTAP and CePReF) and participating in the IeDEA (International epidemiologic databases to Evaluate AIDS project) in Abidjan, Ivory Coast. This study included: (1) an inventory of SRH services, using a questionnaire and direct observation, describing their adaptation to the teenagers' needs and their inclusion in provision of care; (2 an assessment by means of semi-structured interviews of 14 health professionals' perceptions of the SRH needs of the ALHIV subjects with whom they worked. Quantitative data were expressed in percentages and qualitative data from the interviews were analyzed through inductive thematic analysis. RESULTS The care provided in the three facilities was poorly adapted to the teenagers' needs. Few SRH services were effectively provided to the ALHIV subjects in the different centers. The services essentially consisted in condom distribution and organization of SRH-based focus groups. Exceptionally, hormonal contraception was offered to teenage girls. Barriers to the services were largely due to poorly equipped facilities, particularly in terms of SRH offer, health professionals' experience, and support provided for ALHIV subjects and their parents. The health professionals were desirous of SRH skill-building programs enabling them to deliver optimal, adequately contextualized SRH services to the teenagers. CONCLUSIONS In pediatric programs addressed to ALHIV subjects in three Abidjan facilities, the teenagers' SRH needs remain unmet. It is urgently necessary to strengthen the health facilities by means of improved equipment, enhanced awareness of teenagers' needs, and training programs enabling the health professionals to provide more adapted sexual and reproductive health services.
Collapse
Affiliation(s)
| | - J. Jesson
- Inserm, Université de Toulouse 3, CERPOP, Toulouse, France
| | - H. Aka Dago-Akribi
- Département de psychologie, Université de Cocody, Abidjan, Côte d’Ivoire
| | - D.L. Dahourou
- Département biomédical et de santé publique, Institut de recherche en sciences de la santé (IRSS/CNRST), Ouagadougou, Burkina Faso,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - P. Ogbo
- Centre intégré de recherches biocliniques, Abidjan, Côte d’Ivoire
| | - C. Moh
- Département de psychologie, Université de Cocody, Abidjan, Côte d’Ivoire,Programme PACCI, Abidjan, Côte d’Ivoire
| | | | - M-S. N’Gbeche
- Centre de prise en charge, de recherche et de formation, CePReF, Aconda, Abidjan, Côte d’Ivoire
| | - F. Tanoh Eboua
- Department de pédiatrie, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - E. Messou Kouassi
- Centre de prise en charge, de recherche et de formation, CePReF, Aconda, Abidjan, Côte d’Ivoire
| | - K. Kouadio
- Centre intégré de recherches biocliniques, Abidjan, Côte d’Ivoire
| | - M-C. Cacou
- Département de psychologie, Université de Cocody, Abidjan, Côte d’Ivoire
| | - A. Horo
- Service de gynécologie obstétrique, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - P. Msellati
- Programme PACCI, Abidjan, Côte d’Ivoire,UMI TransVIHMI, Institut de recherche pour le développement, Montpellier, France
| | - G. Sturm
- Laboratoire cliniques psychopathologique et interculturelle EA4591, Université de Toulouse 2, Toulouse, France,Service universitaire de psychiatrie de l’enfant et de l’adolescent (SUPEA), CHU de Toulouse, Toulouse, France
| | - V. Leroy
- Inserm, Université de Toulouse 3, CERPOP, Toulouse, France
| | | |
Collapse
|
22
|
Orth Z, van Wyk B. Discourses of Mental Wellness Among Adolescents Living with HIV in Cape Town, South Africa. Psychol Res Behav Manag 2022; 15:1435-1450. [PMID: 35702635 PMCID: PMC9188805 DOI: 10.2147/prbm.s360145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adolescence is a unique period of development where individuals transition from childhood to adulthood, and where they are at heightened risk for developing mental health problems and engaging in risky behaviours. In addition, adolescents living with HIV (ALHIV) must learn to cope with challenges related to the biological impact of a chronic condition, adhering to lifelong treatment, and managing HIV-related psychological and social challenges. Mental wellness as a precursor to mental wellbeing, is vital to facilitate persistent adherence and engagement in care for optimal treatment outcomes for ALHIV. However, little is known about how ALHIV understand and talk about mental wellness in the context being on HIV treatment. Methods We conducted a photovoice study with 12 groups, consisting of 43 ALHIV, aged 15–19 years, and receiving HIV treatment at three public primary health care facilities in the Western Cape Metropole in South Africa. Results Through discourse analysis, we identified six themes that depicted mental wellness concepts that were prominent in their experiences, namely, connectedness, spirituality and mindfulness, social coherence and awareness, self-esteem, self-acceptance, and sense of coherence. In addition, the adolescents gave accounts of six mental wellness behaviours namely, self-efficacy, coping, resilience, life purpose, engagement in enjoyable life activities and physical functioning. Discussion These concepts and behaviours are similar to those identified in targeted interventions aimed at ALHIV. These mental wellness concepts and behaviours are critical to improving health outcomes for ALHIV and should be targeted in the delivery of youth friendly services and integrated HIV care in public healthcare facilities in South Africa and the sub-Saharan African continent.
Collapse
Affiliation(s)
- Zaida Orth
- School of Public Health, University of the Western Cape, Bellville, Western Cape, 7535, South Africa
- Correspondence: Zaida Orth, Tel +27728718490, Email
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Bellville, Western Cape, 7535, South Africa
| |
Collapse
|
23
|
Kip EC, Udedi M, Kulisewa K, Go VF, Gaynes BN. Stigma and mental health challenges among adolescents living with HIV in selected adolescent-specific antiretroviral therapy clinics in Zomba District, Malawi. BMC Pediatr 2022; 22:253. [PMID: 35524228 PMCID: PMC9077887 DOI: 10.1186/s12887-022-03292-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Of the 1.8 million adolescents between the ages of 10 and 19 living with HIV globally in 2020; approximately 1.5 million of these live in sub-Saharan Africa. These adolescents living with HIV (ALHIV) are at higher risk of experiencing mental health problems than those without; in Malawi, 18.9% have a depressive disorder. ALHIV can face numerous psychosocial challenges, but little is known about how ALHIV in Malawi perceive these stressors. Understanding psychosocial challenges of ALHIV is a key step in ensuring good mental health care. The aim of this study was to assess the psychosocial challenges faced by ALHIV attending adolescent-specific ART program in Zomba, Malawi. METHODS Between April and May 2019, we engaged a purposive sample of ALHIV ages 12-18 (n = 80) in a series of eight focus groups drawing from four Teen Clubs linked to an adolescent-specific ART program. Data were analyzed inductively and deductively to identify themes related to ALHIV psychosocial experiences. RESULTS Two themes that emerged from the study include: 1) stigma and discrimination within communities and families; 2) non-adherence to medications. HIV-related stigma was associated with increased psychological distress; physical and emotional/verbal abuse; low social support, isolation, and a feeling of rejection; and risky health behaviors such as medication hiding and non-adherence to ART. Discriminatory actions were manifested in a form of being given separate utensils for their meals and mistreatment at school. Furthermore, some parents did not allow their children to play with the participants out of fear that HIV transmission. CONCLUSIONS Stigma and discrimination are overlooked potential barriers to HIV treatment and care. If HIV services are to effectively meet ALHIVs' needs, mental health interventions are needed to prevent and manage depression and improve adherence to ART. These findings highlight the crucial need to develop culturally relevant mental interventions aimed at helping ALHIV to cope with these diverse challenges.
Collapse
Affiliation(s)
- Esther C Kip
- Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Michael Udedi
- Malawi Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Kazione Kulisewa
- Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Vivian F Go
- University of North Carolina, Chapel Hill, USA
| | | |
Collapse
|
24
|
Roberts KJ, Smith C, Cluver L, Toska E, Zhou S, Boyes M, Sherr L. Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder. AIDS Behav 2022; 26:1197-1210. [PMID: 34570313 PMCID: PMC8940800 DOI: 10.1007/s10461-021-03474-8] [Citation(s) in RCA: 3] [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] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Abstract
The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher’s exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5–12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral.
Collapse
Affiliation(s)
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
| | - Lucie 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
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Mark Boyes
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Perth, Australia
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
25
|
Orth Z, Moosajee F, Van Wyk B. Measuring Mental Wellness of Adolescents: A Systematic Review of Instruments. Front Psychol 2022; 13:835601. [PMID: 35356328 PMCID: PMC8959676 DOI: 10.3389/fpsyg.2022.835601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 12/26/2022] Open
Abstract
Objective Mental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group. Method A systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps. Results We identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose. Conclusion The review reflected previous research identifying a lack of consensus around the definitions of mental health, mental wellness, and mental wellbeing. This has implications for developing instruments for adolescents that adequately measure these constructs. Most of the instruments identified in the review were predominantly English and from developed countries. This indicates a need for instrument that are explicitly conceptualised and operationalised for adolescents in all their varied contexts.
Collapse
Affiliation(s)
- Zaida Orth
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Faranha Moosajee
- Division for Postgraduate Studies, University of the Western Cape, Bellville, South Africa
| | - Brian Van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| |
Collapse
|
26
|
Simms V, Weiss HA, Chinoda S, Mutsinze A, Bernays S, Verhey R, Wogrin C, Apollo T, Mugurungi O, Sithole D, Chibanda D, Willis N. Peer-led counselling with problem discussion therapy for adolescents living with HIV in Zimbabwe: A cluster-randomised trial. PLoS Med 2022; 19:e1003887. [PMID: 34986170 PMCID: PMC8730396 DOI: 10.1371/journal.pmed.1003887] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescents living with HIV have poor virological suppression and high prevalence of common mental disorders (CMDs). In Zimbabwe, the Zvandiri adolescent peer support programme is effective at improving virological suppression. We assessed the effect of training Zvandiri peer counsellors known as Community Adolescent Treatment Supporters (CATS) in problem-solving therapy (PST) on virological suppression and mental health outcomes. METHODS AND FINDINGS Sixty clinics were randomised 1:1 to either normal Zvandiri peer counselling or a peer counsellor trained in PST. In January to March 2019, 842 adolescents aged 10 to 19 years and living with HIV who screened positive for CMDs were enrolled (375 (44.5%) male and 418 (49.6%) orphaned of at least one parent). The primary outcome was virological nonsuppression (viral load ≥1,000 copies/mL). Secondary outcomes were symptoms of CMDs measured with the Shona Symptom Questionnaire (SSQ ≥8) and depression measured with the Patient Health Questionnaire (PHQ-9 ≥10) and health utility score using the EQ-5D. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for clinic-level clustering. Case reviews and focus group discussions were used to determine feasibility of intervention delivery. At baseline, 35.1% of participants had virological nonsuppression and 70.3% had SSQ≥8. After 48 weeks, follow-up was 89.5% for viral load data and 90.9% for other outcomes. Virological nonsuppression decreased in both arms, but there was no evidence of an intervention effect (prevalence of nonsuppression 14.7% in the Zvandiri-PST arm versus 11.9% in the Zvandiri arm; AOR = 1.29; 95% CI 0.68, 2.48; p = 0.44). There was strong evidence of an apparent effect on common mental health outcomes (SSQ ≥8: 2.4% versus 10.3% [AOR = 0.19; 95% CI 0.08, 0.46; p < 0.001]; PHQ-9 ≥10: 2.9% versus 8.8% [AOR = 0.32; 95% CI 0.14, 0.78; p = 0.01]). Prevalence of EQ-5D index score <1 was 27.6% versus 38.9% (AOR = 0.56; 95% CI 0.31, 1.03; p = 0.06). Qualitative analyses found that CATS-observed participants had limited autonomy or ability to solve problems. In response, the CATS adapted the intervention to focus on empathic problem discussion to fit adolescents' age, capacity, and circumstances, which was beneficial. Limitations include that cost data were not available and that the mental health tools were validated in adult populations, not adolescents. CONCLUSIONS PST training for CATS did not add to the benefit of peer support in reducing virological nonsuppression but led to improved symptoms of CMD and depression compared to standard Zvandiri care among adolescents living with HIV in Zimbabwe. Active involvement of caregivers and strengthened referral structures could increase feasibility and effectiveness. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201810756862405.
Collapse
Affiliation(s)
- Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Sarah Bernays
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Tsitsi Apollo
- AIDS & TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS & TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Dorcas Sithole
- Mental Health Services, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Dixon Chibanda
- Friendship Bench, Harare, Zimbabwe
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | |
Collapse
|
27
|
Mmanga C, Ndasauka Y, Kainja J, Kondowe F, Mchenga M, Maliwichi L, Nyamali S. The world is coming to an end! COVID-19, depression, and anxiety among adolescents in Malawi. Front Psychiatry 2022; 13:1024793. [PMID: 36684001 PMCID: PMC9849886 DOI: 10.3389/fpsyt.2022.1024793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION This paper assessed the effects of Covid-19 on adolescent mental health in Malawi. There is minimal research on adolescent mental health in Africa, Malawi in particular. The study shows a link between the pandemic and mental health. Some factors that may have contributed to this link include; Covid-19 preventive measures, media exposure and the increase in unemployment. METHODS The study used a mixed methods approach, quantitative and qualitative methods. It was conducted in Malawi's four districts (Blantyre, Mangochi, Lilongwe and Karonga). RESULTS Overall 22%, 21%, and 23% of the respondents had depression, anxiety and post-traumatic stress disorder, respectively. The Chi-square test showed that significantly more adolescents with secondary education (28%) had anxiety than those with primary education (14%). Further, regression analysis revealed that adolescents with anxiety were 18 [95%CI: 9.34, 35.8] times more likely to have depression compared to those who did not have anxiety. The study found no significant differences in the proportions of adolescents with the three outcomes when comparing different groups within the explanatory variable. The ratio of female and male adolescents with depression and anxiety was the same. DISCUSSION The adolescents expressed that Covid-19 affected their social, academic, and financial status. These effects had a significant bearing on their mental health in that they led to depression, anxiety, fear of the unknown, and stress. During the Covid-19 pandemic, adolescents' mental health diminished and posed a considerable risk to productivity of adolescents. As a result, adolescents may not fully realize their potential, form and maintain good relationships, contribute to their community and become resilient. These effects have devastating consequences for this young generation without proper coping strategies.
Collapse
Affiliation(s)
| | | | - Jimmy Kainja
- Department of Philosophy, University of Malawi, Zomba, Malawi
| | - Fiskani Kondowe
- Department of Philosophy, University of Malawi, Zomba, Malawi
| | - Martina Mchenga
- Department of Media and Communication Studies, University of Cape Town, Cape Town, South Africa
| | | | - Simunye Nyamali
- Department of Mathematical Sciences, University of East Anglia, Norwich, United Kingdom
| |
Collapse
|
28
|
Orth Z, van Wyk B. A Facility-based Family Support Intervention to Improve Treatment Outcomes for Adolescents on Antiretroviral Therapy in the Cape Metropole, South Africa. J Int Assoc Provid AIDS Care 2021; 20:23259582211059289. [PMID: 34821168 PMCID: PMC8641108 DOI: 10.1177/23259582211059289] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adolescents living with human immunodeficiency virus (HIV) (ALHIV) globally, report worse treatment outcomes compared to adults and children on antiretroviral therapy (ART). We conducted a photovoice study with eighteen ALHIV to explore experiences and challenges of being on ART, and individual interviews with 5 health workers to describe the challenges in treating ALHIV. The facility implemented the Family club intervention to facilitate caregivers (parent/guardians) supporting ALHIV on treatment. The health workers revealed that "disclosing HIV status" to children was the biggest challenge for caregivers and health workers. Participating ALHIV reported that family support and having a positive mentality were instrumental for continued treatment adherence. However, disclosure of HIV status to friends remained a challenge due to pervasive community stigma. Treatment fatigue and side-effects were also barriers to adherence. Family support was instrumental in facilitating adherence support for ALHIV. However, this (intervention) should include peer support to improve positive mental well-being in ALHIV.
Collapse
Affiliation(s)
- Zaida Orth
- School of Public Health, 56390University of the Western Cape, Bellville, South Africa
| | - Brian van Wyk
- School of Public Health, 56390University of the Western Cape, Bellville, South Africa
| |
Collapse
|
29
|
Ford N, Eshun-Wilson I, Ameyan W, Newman M, Vojnov L, Doherty M, Geng E. Future directions for HIV service delivery research: Research gaps identified through WHO guideline development. PLoS Med 2021; 18:e1003812. [PMID: 34555010 PMCID: PMC8496797 DOI: 10.1371/journal.pmed.1003812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/07/2021] [Indexed: 11/19/2022] Open
Abstract
Nathan Ford and co-authors discuss the systematic identification of research gaps in improving HIV service delivery.
Collapse
Affiliation(s)
- Nathan Ford
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Wole Ameyan
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Morkor Newman
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Lara Vojnov
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| |
Collapse
|
30
|
Laurenzi CA, du Toit S, Ameyan W, Melendez‐Torres GJ, Kara T, Brand A, Chideya Y, Abrahams N, Bradshaw M, Page DT, Ford N, Sam‐Agudu NA, Mark D, Vitoria M, Penazzato M, Willis N, Armstrong A, Skeen S. Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta-analysis. J Int AIDS Soc 2021; 24:e25741. [PMID: 34338417 PMCID: PMC8327356 DOI: 10.1002/jia2.25741] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Adolescents and young people comprise a growing proportion of new HIV infections globally, yet current approaches do not effectively engage this group, and adolescent HIV-related outcomes are the poorest among all age groups. Providing psychosocial interventions incorporating psychological, social, and/or behavioural approaches offer a potential pathway to improve engagement in care and health and behavioural outcomes among adolescents and young people living with HIV (AYPLHIV). METHODS A systematic search of all peer-reviewed papers published between January 2000 and July 2020 was conducted through four electronic databases (Cochrane Library, PsycINFO, PubMed and Scopus). We included randomized controlled trials evaluating psychosocial interventions aimed at improving engagement in care and health and behavioural outcomes of AYPLHIV aged 10 to 24 years. RESULTS AND DISCUSSION Thirty relevant studies were identified. Studies took place in the United States (n = 18, 60%), sub-Saharan Africa (Nigeria, South Africa, Uganda, Zambia, Zimbabwe) and Southeast Asia (Thailand). Outcomes of interest included adherence to antiretroviral therapy (ART), ART knowledge, viral load data, sexual risk behaviours, sexual risk knowledge, retention in care and linkage to care. Overall, psychosocial interventions for AYPLHIV showed important, small-to-moderate effects on adherence to ART (SMD = 0.3907, 95% CI: 0.1059 to 0.6754, 21 studies, n = 2647) and viral load (SMD = -0.2607, 95% CI -04518 to -0.0696, 12 studies, n = 1566). The psychosocial interventions reviewed did not demonstrate significant impacts on retention in care (n = 8), sexual risk behaviours and knowledge (n = 13), viral suppression (n = 4), undetectable viral load (n = 5) or linkage to care (n = 1) among AYPLHIV. No studies measured transition to adult services. Effective interventions employed various approaches, including digital and lay health worker delivery, which hold promise for scaling interventions in the context of COVID-19. CONCLUSIONS This review highlights the potential of psychosocial interventions in improving health outcomes in AYPLHIV. However, more research needs to be conducted on interventions that can effectively reduce sexual risk behaviours of AYPLHIV, as well as those that can strengthen engagement in care. Further investment is needed to ensure that these interventions are cost-effective, sustainable and resilient in the face of resource constraints and global challenges such as the COVID-19 pandemic.
Collapse
Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Stefani du Toit
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - GJ Melendez‐Torres
- Peninsula Technology Assessment GroupUniversity of ExeterExeterUnited Kingdom
| | - Tashmira Kara
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Amanda Brand
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
- Division of Epidemiology and BiostatisticsDepartment of Global HealthFaculty of Medicine and Health SciencesCentre for Evidence‐Based Health CareStellenbosch UniversityTygerbergSouth Africa
| | - Yeukai Chideya
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Nina Abrahams
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Melissa Bradshaw
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Daniel T Page
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Nathan Ford
- Global HIV, Hepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Nadia A Sam‐Agudu
- Pediatric and Adolescent UnitPrevention, Care and Treatment DepartmentInstitute of Human Virology NigeriaAbujaNigeria
- Institute of Human Virology and Department of PediatricsUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Daniella Mark
- Paediatric Adolescent Treatment AfricaCape TownSouth Africa
| | - Marco Vitoria
- Global HIV, Hepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Martina Penazzato
- Global HIV, Hepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | | | - Alice Armstrong
- UNICEF Eastern and Southern Africa Regional OfficeNairobiKenya
| | - Sarah Skeen
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| |
Collapse
|
31
|
Filiatreau LM, Pettifor A, Edwards JK, Masilela N, Twine R, Xavier Gómez-Olivé F, Haberland N, Kabudula CW, Lippman SA, Kahn K. Associations Between Key Psychosocial Stressors and Viral Suppression and Retention in Care Among Youth with HIV in Rural South Africa. AIDS Behav 2021; 25:2358-2368. [PMID: 33624194 PMCID: PMC8222008 DOI: 10.1007/s10461-021-03198-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/20/2022]
Abstract
Despite improvements in access to antiretroviral treatment over the past decade, sub-optimal HIV care outcomes persist among youth with HIV (YWH) in rural South Africa. Psychosocial stressors could impede improved HIV treatment outcomes within this population. We linked self-reported psychosocial health and demographic data from a cross-sectional survey conducted among YWH aged 12-24 in rural South Africa to individual medical record data, including facility visit history and viral load measurements. Poisson regression with robust standard errors was used to estimate the associations between five psychosocial stressors- heightened depressive symptoms (Center for Epidemiological Studies-Depression scale scores ≥ 16), lower social support (Medical Outcomes Social Support Scale scores ≤ 38), lower resilience (Conner-Davidson Resilience Scale scores ≤ 73), lower self-esteem (Rosenberg Self-Esteem Scale scores ≤ 21), and higher perceived stress (Sheldon Cohen Perceived Stress Scale scores ≥ 10)- and viral non-suppression (viral load ≥ 400 copies/mL) and loss to care (no documented clinic visits within the 90 days prior to survey), separately. A total of 359 YWH were included in this analysis. The median age of study participants was 21 (interquartile range: 16-23), and most were female (70.2%), single (82.4%), and attending school (54.7%). Over a quarter of participants (28.1%) had heightened depressive symptoms. Just 16.2% of all participants (n = 58) were lost to care at the time of survey, while 32.4% (n = 73) of the 225 participants with viral load data were non-suppressed. The prevalence of non-suppression in individuals with lower self-esteem was 1.71 (95% confidence interval: 1.12, 2.61) times the prevalence of non-suppression in those with higher self-esteem after adjustment. No meaningful association was observed between heightened depressive symptoms, lower social support, lower resilience, and higher perceived stress and viral non-suppression or loss to care in adjusted analyses. Retention in care and viral suppression among YWH in rural South Africa are below global targets. Interventions aimed at improving viral suppression among YWH should incorporate modules to improve participant's self-esteem as low self-esteem is associated with viral non-suppression in this setting. Future studies should longitudinally explore the joint effects of co-occurring psychosocial stressors on HIV care outcomes in YWH and assess meaningful differences in these effects by age, gender, and route of transmission.
Collapse
Affiliation(s)
- Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - Nkosinathi Masilela
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
32
|
Disparities between HIV patient subgroups in Oman: An analysis of the 2019 cascade of care. PLoS One 2021; 16:e0254474. [PMID: 34242337 PMCID: PMC8270432 DOI: 10.1371/journal.pone.0254474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background The HIV cascade of care is a framework for monitoring HIV care, identifying gaps and informing appropriate interventions. This study aimed to describe the cascade of care in Oman in 2019 and highlight disparities at the sub-population level. Methods We used the UNAIDS Spectrum modelling software to estimate the number of people living with HIV. A national HIV surveillance database was used to identify Omani people (≥13 years old) diagnosed with HIV from 1984 through December 2019. We calculated the cascade indicators as of 31 December 2019 stratified by sex, age, HIV risk factor, residence, and region of HIV care. We also performed multivariate logistic regression to determine the predictors of attrition at linkage, retention, on ART, and viral suppression. Results As of December 2019, the estimated number of people living with HIV in Oman was 2440. Out of the estimated number of people living with HIV, 69% were diagnosed, 66% were linked to care, 61% were retained in care, 60% were on ART, and 55% were virally suppressed. Of the 1673 diagnosed individuals, 96% were linked to care, 88% were retained in care, 87% were on ART, and 81% were virally suppressed. People who received HIV care outside Muscat had the largest attrition (11% loss) in the transition from linkage (97%) to retention (86%). Similarly, people aged 13–24 years had the largest attrition (13% loss) from “on ART” (88%) to viral suppression (75%). Logistic regression showed that both not reporting a specific HIV risk factor and receipt of HIV care outside Muscat independently predicted attrition at each cascade stage from linkage to care through viral suppression. Conclusions Our findings identified substantial disparities across various subpopulations along the cascade of care in Oman. This analysis will be invaluable in informing future interventions targeting patient subgroups who are at the highest risk of attrition.
Collapse
|
33
|
Roberts KJ, Smith C, Cluver L, Toska E, Sherr L. Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap. AIDS Behav 2021; 25:2094-2107. [PMID: 33452658 PMCID: PMC7810185 DOI: 10.1007/s10461-020-03138-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/28/2022]
Abstract
Adolescent (10-19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defined search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identified 2287 unique records. Of these, thirty-eight full-text quantitative records and seven full-text qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identified for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identified reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specific interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identified within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifies a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities.
Collapse
Affiliation(s)
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
| | - Lucie 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
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
34
|
Bhana A, Kreniske P, Pather A, Abas MA, Mellins CA. Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence. J Int AIDS Soc 2021; 24 Suppl 2:e25713. [PMID: 34164939 PMCID: PMC8222850 DOI: 10.1002/jia2.25713] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/26/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Adolescents and young adults (AYA) remain vulnerable to HIV-infection and significant co-morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence-based mental health interventions for AYALH and AYAAH to inform future work. METHODS The review, targeting work between 2014 and 2020, initially included studies of evidence-based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes. RESULTS AND DISCUSSION We identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub-Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence-based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group-based and family strengthening interventions, economic empowerment combined with family strengthening, group-based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group-based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health. CONCLUSIONS Despite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence-based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.
Collapse
Affiliation(s)
- Arvin Bhana
- Health Systems Research UnitSouth African Medical Research CouncilDurbanSouth Africa
- Centre for Rural HealthCollege of Health SciencesUniversity of KwaZulu‐NatalSouth Africa
| | - Philip Kreniske
- HIV Center for Clinical and Behavioral StudiesDepartment of PsychiatryNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | - Ariana Pather
- HIV Center for Clinical and Behavioral StudiesDepartment of PsychiatryNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | - Melanie Amna Abas
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral StudiesDepartment of PsychiatryNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| |
Collapse
|
35
|
Okumu M, Nyoni T, Byansi W. Alleviating psychological distress and promoting mental wellbeing among adolescents living with HIV in sub-Saharan Africa, during and after COVID-19. Glob Public Health 2021; 16:964-973. [PMID: 33843460 DOI: 10.1080/17441692.2021.1912137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
COVID-19 social control measures (e.g. physical distancing and lockdowns) can have both immediate (social isolation, loneliness, anxiety, stress) and long-term effects (depression, post-traumatic stress disorder) on individuals' mental health. This may be particularly true of adolescents living with HIV (ALHIV) and their caregivers - populations already overburdened by intersecting stressors (e.g. psychosocial, biomedical, familial, economic, social, or environmental). Addressing the adverse mental health sequelae of COVID-19 among ALHIV requires a multi-dimensional approach that at once (a) economically empowers ALHIV and their households and (b) trains, mentors, and supervises community members as lay mental health services providers. Mental health literacy programming can also be implemented to increase mental health knowledge, reduce stigma, and improve service use among ALHIV. Schools and HIV care clinics offer ideal environments for increasing mental health literacy and improving access to mental health services.
Collapse
Affiliation(s)
- Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Thabani Nyoni
- Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - William Byansi
- Brown School of Social Work, Washington University, St. Louis, MO, USA
| |
Collapse
|
36
|
Wogrin C, Willis N, Mutsinze A, Chinoda S, Verhey R, Chibanda D, Bernays S. It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV. PLoS One 2021; 16:e0248018. [PMID: 33657185 PMCID: PMC7928463 DOI: 10.1371/journal.pone.0248018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. METHODS We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18-24) from across 10 intervention districts and audio recorded 200 of the peer supporters' monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. RESULTS A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. CONCLUSION Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.
Collapse
Affiliation(s)
| | | | | | | | - Ruth Verhey
- Friendship Bench, Avondale, Harare, Zimbabwe
| | - Dixon Chibanda
- Friendship Bench, Avondale, Harare, Zimbabwe
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Bernays
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Public Health, University of Sydney, Sydney, Australia
| |
Collapse
|
37
|
Shenderovich Y, Boyes M, Esposti MD, Casale M, Toska E, Roberts KJ, Cluver L. Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa. BMC Public Health 2021; 21:172. [PMID: 33472607 PMCID: PMC7816135 DOI: 10.1186/s12889-020-10147-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. METHODS The study traced adolescents aged 10-19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. RESULTS Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97-0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98-1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92-0.97, p<.0001) and anxiety (0.91, 95% CI 0.89-0.94, p<.0001) symptoms reported by adolescents. CONCLUSIONS Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.
Collapse
Affiliation(s)
- Yulia Shenderovich
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Mark Boyes
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Michelle Degli Esposti
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Marisa Casale
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Elona Toska
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | | | - Lucie Cluver
- Centre for Evidence-Based Intervention, 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
| |
Collapse
|
38
|
Nsibandze BS, Downing C, Poggenpoel M, Myburgh CP. “I have been rejected so many times” experiences of female adolescents living with HIV in rural Manzini, Eswatini: A case study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|