1
|
Kayiranga D, Mukamana D, Gishoma D, Relf MV. "Successful Living" Among Adolescents With HIV in Sub-Saharan Africa: An Evolutionary Concept Analysis. J Assoc Nurses AIDS Care 2024; 35:376-387. [PMID: 39196685 PMCID: PMC11356674 DOI: 10.1097/jnc.0000000000000485] [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] [Indexed: 08/30/2024]
Abstract
ABSTRACT The concept of successful living in the context of adolescents with HIV lacks clarity and is unexplored. Without a common understanding of successful living among adolescents with HIV (AWH) in Sub-Saharan Africa (SSA), health care interventions focusing on this population may continue to fall short, resulting in avoidable morbidity and mortality. Therefore, this analysis used Rodgers Evolutionary Concept Analysis method to identify attributes, antecedents, consequences, and related concepts of successful living among AWH in SSA. Health care interventions are encouraged to promote successful living among AWH to achieve behavioral and clinical outcomes.
Collapse
Affiliation(s)
- Dieudonne Kayiranga
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD Student, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda, and is a Visiting Scholar, Duke University School of Nursing, Durham, North Carolina, USA. Donatilla Mukamana, PhD, RMHN, FAAN, is a Professor of Mental Health Nursing, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Darius Gishoma, PhD, RMHN, is an Associate Professor of Clinical Psychology, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Michael V. Relf, PhD, RN, AACRN, ANEF, FAAN, is the Interim Dean and Mary T. Champagne Distinguished Professor, Duke University School of Nursing, Durham, North Carolina, USA
| | - Donatilla Mukamana
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD Student, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda, and is a Visiting Scholar, Duke University School of Nursing, Durham, North Carolina, USA. Donatilla Mukamana, PhD, RMHN, FAAN, is a Professor of Mental Health Nursing, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Darius Gishoma, PhD, RMHN, is an Associate Professor of Clinical Psychology, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Michael V. Relf, PhD, RN, AACRN, ANEF, FAAN, is the Interim Dean and Mary T. Champagne Distinguished Professor, Duke University School of Nursing, Durham, North Carolina, USA
| | - Darius Gishoma
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD Student, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda, and is a Visiting Scholar, Duke University School of Nursing, Durham, North Carolina, USA. Donatilla Mukamana, PhD, RMHN, FAAN, is a Professor of Mental Health Nursing, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Darius Gishoma, PhD, RMHN, is an Associate Professor of Clinical Psychology, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Michael V. Relf, PhD, RN, AACRN, ANEF, FAAN, is the Interim Dean and Mary T. Champagne Distinguished Professor, Duke University School of Nursing, Durham, North Carolina, USA
| | - Michael V. Relf
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD Student, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda, and is a Visiting Scholar, Duke University School of Nursing, Durham, North Carolina, USA. Donatilla Mukamana, PhD, RMHN, FAAN, is a Professor of Mental Health Nursing, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Darius Gishoma, PhD, RMHN, is an Associate Professor of Clinical Psychology, Department of Mental Health, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda. Michael V. Relf, PhD, RN, AACRN, ANEF, FAAN, is the Interim Dean and Mary T. Champagne Distinguished Professor, Duke University School of Nursing, Durham, North Carolina, USA
| |
Collapse
|
2
|
Kizito S, Namuwonge F, Nabayinda J, Nalwanga D, Najjuuko C, Nabunya P, Atwebembere R, Namuyaba OI, Mukasa M, Ssewamala FM. A Cluster-Randomized Controlled Trial of an Economic Strengthening Intervention to Enhance Antiretroviral Therapy Adherence among Adolescents Living with HIV. AIDS Behav 2024; 28:1570-1580. [PMID: 38231361 PMCID: PMC11070301 DOI: 10.1007/s10461-024-04268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
We examined the impact of an economic empowerment intervention on ART adherence among ALHIV. We used data from 455 ALHIV, randomized into intervention, n = 111, and control n = 344. ALHIV were aged 12-16 and recruited from 39 clinics in Uganda between January 2013 and December 2015. The intervention comprised a long-term child development account (CDA), micro-enterprise workshops, and educational sessions. Adherence was measured using unannounced pill counts. We used mixed-effects logistic regression analysis to examine the effect of the intervention on ART adherence. The mean age was 12.6 years. Despite observing non-significant group main effects, we found significant group-by-time interaction effects χ2(5) = 45.41, p < 0.001. Pairwise comparisons showed that compared to the control group, participants who received the intervention had significantly higher adherence at visit four, OR = 1.52 (95% CI: 1.07-2.18), p = 0.020; visit five, OR = 1.59 (95% CI: 1.06-2.38), p = 0.026; and visit six, OR = 1.94 (95% CI: 1.24-3.04), p = 0.004. Efforts to support ALHIV to live longer and healthier lives should incorporate components addressing poverty. However, declining adherence raises concerns over ALHIV's long-term well-being. The trial was registered at ClinicalTrials.gov, registration number NCT01790373, with a primary outcome of adherence to HIV treatment.
Collapse
Affiliation(s)
- Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Damalie Nalwanga
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Claire Najjuuko
- International Center for Child Health and Development, Masaka, Uganda
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | | | | | - Miriam Mukasa
- International Center for Child Health and Development, Masaka, Uganda
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
| |
Collapse
|
3
|
Arroyo-Jiménez C, Benjet C, Robles R, Caballero-Suárez NP, Gálvez-Hernández CL, Ordoñez-Ortega J, Suárez-Maldonado MT, Xochihua L. Social and mental health characteristics of adolescents living with HIV in Mexico: Implications for adherence to antiretroviral treatment. J Health Psychol 2024; 29:289-302. [PMID: 37933118 DOI: 10.1177/13591053231207474] [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] [Indexed: 11/08/2023] Open
Abstract
Mexico is the third Latin American country with the most children and adolescents living with human immunodeficiency virus (ALHIV). There is a lack of information on the characteristics of this population. We aimed to describe the social and mental health characteristics of Mexican ALHIV. A census was conducted of all adolescent patients with HIV at a pediatric hospital (n = 47; mean age 14.39, S.D. = 3.65) and their caregivers. We collected data on socio-demographic characteristics, family, intelligence, mental health, adverse life events, substance use, treatment, knowledge of Antiretroviral Treatment (ART) and HIV, and biomarkers. Most cases were transmitted vertically and self-reported ART adherence was above 90%. Some obstacles to adherence were medicine discomfort, believing that they did not need it, and forgetfulness. The vulnerabilities were intellectual disability, adverse life events, possible mental health problems, and little knowledge of their illness and treatment. These findings suggest the importance of interventions to improve the perception and knowledge of HIV and ART to increase ART adherence.
Collapse
Affiliation(s)
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Rebeca Robles
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Nancy Patricia Caballero-Suárez
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Mexico
| | | | | | | | | |
Collapse
|
4
|
Buh A, Deonandan R, Gomes J, Krentel A, Oladimeji O, Yaya S. Barriers and facilitators to ART adherence among ART non-adherence people living with HIV in Cameroon: A qualitative phenomenological study. PLoS One 2023; 18:e0291487. [PMID: 37699048 PMCID: PMC10497158 DOI: 10.1371/journal.pone.0291487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) needs to be taken for life with near perfect levels of adherence for it to be effective. Nonetheless, ART non-adherence is still observed in sub-Saharan African (SSA) countries such as Cameroon. The objective of this study was to assess the factors influencing non-adherence and or adherence among people living with HIV (PLWH) who have experienced non-adherence to ART in Cameroon. METHODS A descriptive qualitative study of PLWH who have experienced non-adherence with ART in Cameroon was conducted. Data were collected using in-depth interviews. Collected data were analyzed using the NVIVO 12 software. RESULTS In total, 43 participants participated in this study. The Southwest and Littoral regions each contributed 15 (34.88%) of participants, participants' mean age was 37.1 years (SD: 9.81) and majority 34 (82.93%) were females. ART adherence barriers include those related to patient (forgetfulness, business with other things, unwillingness to swallow drugs daily), medication (side effects), health service (arrogance of caregivers, occasional drug shortages at treatment centre, poor counseling of patient), stigma (fear of status disclosure), use of alternative treatment (traditional medicine, prayers and deliverance), resource limitation (limited food, limited finances), environmental/social (limited or no home support), and political instability (disruption of free circulation by ghost towns, roadblocks and gunshots in some regions). ART adherence facilitators include social support (family and peer support), aligning treatment with patient's daily routines (align ART with schedule of family members), use of reminders (phone alarm, sound of church bell), health sector/caregiver support (messages to patient, financial support, proper counseling), and patient's awareness of HIV status/ART knowledge (awareness of HIV positive status, Knowledge of ART benefits). CONCLUSION ART adherence barriers in Cameroon include those related to patient, medication, health service, stigma, use of alternative treatment, resource limitation, environmental/social, and political instability. ART adherence facilitators include social support, aligning treatment with patient's daily routines, use of reminders, health sector/caregiver support, and patient's awareness of HIV status/ART knowledge. Given these barriers and facilitators, continuous information provision and consistent support both from patients' families and caregivers are needed to improve adherence among patients. Further studies including many regions and larger samples using both in-depth and focused group discussions as well as quantitative approaches are required to uncover the burden related to ART non-adherence.
Collapse
Affiliation(s)
- Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Raywat Deonandan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| |
Collapse
|
5
|
Garriott A, Gulubane G, Poku OB, Archibald N, Entaile P, Tshume O, Phoi O, Matshaba M, Ahmed CV, Lowenthal ED, Brooks M. Youth perspectives of working with near peer youth lay counsellors: The Safe Haven Pilot. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:3029-3043. [PMID: 37470744 PMCID: PMC10819599 DOI: 10.1002/jcop.23080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
Youth living with HIV (YLWH) have higher rates of common mental disorders (CMDs) when compared with HIV-negative youth. We adapted the Friendship Bench to create a problem solving-based counselling intervention in Botswana delivered by near peer youth lay counsellors for YLWH called Safe Haven. In August 2020, and from June to August 2021, we conducted 22 semistructured interviews with youth aged 13-25 years with mild-to-moderate symptoms of CMDs. Two independent coders carried out an inductive thematic analysis of the transcribed interviews with discrepancies discussed to consensus. Safe Haven was seen as largely acceptable among the youth. Youth felt Safe Haven was a place where they had freedom of expression and could receive practical advice from well-trained and approachable counsellors. Trained youth lay peer counsellors show promise to meet the mental health needs of mild and moderately symptomatic youth, where mental health professionals are in short supply.
Collapse
Affiliation(s)
- Anna Garriott
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Ohemaa B. Poku
- Columbia-WHO Center for Global Mental Health, New York, New York, USA
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Nicole Archibald
- Columbia-WHO Center for Global Mental Health, New York, New York, USA
| | | | - Ontibile Tshume
- Botswana Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Onkemetse Phoi
- Botswana Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Botswana Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Charisse V. Ahmed
- Department of General Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Elizabeth D. Lowenthal
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Merrian Brooks
- Botswana UPENN Partnership, Gaborone, Botswana
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Masresha SA, Kidie AA, Alen GD, Mulaw GF, Feleke FW, Kassaw MW, Dejene TM. Virological failure and its predictors among human immunodeficiency virus infected individuals on second line antiretroviral treatment in North-East Ethiopia, 2021. Pharmacoepidemiol Drug Saf 2023; 32:978-987. [PMID: 36974512 DOI: 10.1002/pds.5625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/25/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Acquired immune deficiency syndrome (AIDS) becomes a manageable chronic disease due to the presence of effective prevention, diagnosis, treatment, and care accesses. Viral load cascade analyses are important to identify gaps in human immunodeficiency virus (HIV)/AIDS treatment and care for quality improvements. OBJECTIVE Time to Virological Failure and its Predictors among HIV Infected Individuals on Second Line Antiretroviral Treatment (SLART) in North-East Ethiopia, 2021. METHODS Institution-based retrospective follow-up study was conducted on 474 HIV-infected individuals who were on SLART between September 2016 and April 2020. A universal sampling technique was used to recruit study participants. Data were entered by EpiData-3.3.1 and analyzed by STATA-14. Cox proportional hazard assumptions were checked to determine the effect of predictor variables on virological failure (VF). The study was conducted from February 1 to April 30, 2021. RESULTS The rate of VF in this study was 15.4% with an incidence rate of 4.93 per 100 person-years. As participants' age and duration of ART use increased by 1 year the hazards of VF was reduced by 2.9% (AHR: 0.971, 95% CI: 0.945, 0.995) and 10.6% (AHR: 0.894, 95% CI: 0.828, 0.963), respectively. The hazards of VF were twice higher among those who were on a non-protease inhibitor-based regimen. Individuals who had a history of making enhanced adherence counseling (EAC) sessions during SLART had three times more risk to develop VF (AHR: 3.374, 95% CI: 1.790, 6.361). CONCLUSION AND RECOMMENDATIONS The rate of VF among SLART users was high. Keeping SLART users on PI-based regimens may improve virological outcomes in HIV care and treatment. Making EAC sessions effective in promoting better ART adherence might reduce VF.
Collapse
Affiliation(s)
| | | | - Gedefaw Diress Alen
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | | | | | | | - Tadesse Mamo Dejene
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| |
Collapse
|
7
|
Brooks M, Burmen B, Olashore A, Gezmu AM, Molebatsi K, Tshume O, Phoi O, Morales K, Matshaba M, Benton T, Lowenthal ED. Symptoms of depression, anxiety, and thoughts of suicide/self-injury in adolescents and young adults living with HIV in Botswana. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:54-62. [PMID: 37116112 PMCID: PMC10787227 DOI: 10.2989/16085906.2023.2186252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 04/30/2023]
Abstract
Globally, mental health problems have been reported to be more common in youth living with HIV (YLWH) than in the general population, but routine mental health screening is rarely done in high-volume HIV clinics. In 2019, YLWH in a large HIV clinic in Botswana were screened using the Generalized Anxiety Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in a pilot standard-of-care screening programme. Two-way ANOVA was used to describe the effects of age group (12-<16, 16-<20 and 20-25 years old) and sex on GAD-7 and PHQ-9 scores. Chi-square statistics were used to compare characteristics of YLWH with and without potential suicidality/self-harm symptoms based on question 9 in the PHQ-9. Among 1 469 YLWH, 33.1%, 44.3% and 15.0% had anxiety, depression and potential suicidality/self-harm symptoms respectively. YLWH of 20-25 years old and 16-<20 years old had higher GAD-7 scores compared to 12-<16-year-olds (p = 0.014 and p = <0.001 respectively). Female YLWH of 20-25 years old had higher PHQ-9 scores compared to 12-<16-year-olds (p = 0.002). There were no other sex-age dynamics that were statistically significant. Female YLWH endorsed more thoughts of suicidality/self-harm than males (17% versus 13%, p = 0.03 respectively). Given the proportion of YLWH with mental health symptoms, Botswana should enhance investments in mental health services for YLWH, especially for young female adults who bear a disproportionate burden.
Collapse
Affiliation(s)
- Merrian Brooks
- Department of Pediatrics, Craig Dalsimer Division of Adolescent Medicine, Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Anthony Olashore
- Department of Psychiatry, University of Botswana, Gaborone, Botswana
| | | | | | - Ontibile Tshume
- Botswana Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Onkemetse Phoi
- Botswana Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Knashawn Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Mogomotsi Matshaba
- Department of Psychiatry, University of Botswana, Gaborone, Botswana
- Division of Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Tami Benton
- Department of Psychiatry and Behavioral Services, University of Pennsylvania Perelman School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, USA
| | - Elizabeth D Lowenthal
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, USA
| |
Collapse
|
8
|
Pickering stabilizing capacity of Plasma-treated Grass pea protein nanoparticles. J FOOD ENG 2023. [DOI: 10.1016/j.jfoodeng.2023.111458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
9
|
Atanuriba GA, Apiribu F, Dzomeku VM, Amooba PA, Boamah Mensah AB, Afaya RA, Gazari T, Laari TT, Akor MH, Abnory L. "Some believe those who say they can cure it" perceived barriers to antiretroviral therapy for children living with HIV/AIDS: Qualitative exploration of caregivers experiences in tamale metropolis. PLoS One 2022; 17:e0275529. [PMID: 36194615 PMCID: PMC9531795 DOI: 10.1371/journal.pone.0275529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV/AIDS is now a chronic disease, as adherence to anti-retrovirals impacts positively on the quality as well as expectancy of life. However, there exist multifaceted barriers to treatments for which children are most disadvantaged. Since Ghana subscribed to the "treat all" policy less percentage (25.5%) of children (2-14 years) living with HIV/AIDS have been enrolled on the antiretroviral program compared to other categories of the population by 2019. At present no study has explored these barriers to children living with HIV/AIDS enrollment and adherence. This study aims to explore the perceived barriers of caregivers of children living with HIV/AIDS in the Tamale Metropolis. METHODS We used descriptive phenomenology to explore the phenomena. Caregivers were purposively selected and interviewed till information became repetitive at the ninth (9th) caregiver. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews which were audio recorded. The interviews lasted an average of 47 minutes. Audio interviews were transcribed verbatim (English) and translated back-to-back (Daghani) before analysis was done manually according to Collaizi's seven-step approach. We used the Guba and Lincoln guidelines to ensure the rigour of the study and its findings. Results are presented in themes and supported with quotes. RESULTS Six themes emerged from the analysis of the caregivers' transcripts; (1) denial of HIV/AID diagnosis, (2) stock-outs and privacy at the clinic, (3) busy schedule and poor support, (4) ignorance and alternative herbal cure, (5) stigma and discrimination, (6) transportation and distance. CONCLUSION Perceived barriers are multi-dimensional and encountered by all PLWHA, especially children. These barriers could derail the gains of HIV/AIDS interventions among children. Adherence counselling among caregivers alongside campaigns among faith and herbal healers are of grave concern to reduce myths of cure.
Collapse
Affiliation(s)
| | - Felix Apiribu
- Department of Nursing, Faculty of Allied Health Sciences, College of Health, Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Veronica Millicent Dzomeku
- Department of Nursing, Faculty of Allied Health Sciences, College of Health, Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Philemon Adoliwine Amooba
- Department of Nursing, Faculty of Allied Health Sciences, College of Health, Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, Faculty of Allied Health Sciences, College of Health, Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Adongo Afaya
- School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Timothy Gazari
- School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Timothy Tienbia Laari
- Department of Nursing, Faculty of Allied Health Sciences, College of Health, Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Presbyterian Primary Health Care (PPHC), Bolgatanga, Ghana
| | - Moses Haruna Akor
- Nurses and Midwifery Training College-Damongo, Savanna Region, Ghana
| | | |
Collapse
|
10
|
Hendricks LA, Young T, Van Wyk SS, Matheï C, Hannes K. Storyboarding HIV Infected Young People's Adherence to Antiretroviral Therapy in Lower- to Upper Middle-Income Countries: A New-Materialist Qualitative Evidence Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11317. [PMID: 36141589 PMCID: PMC9517626 DOI: 10.3390/ijerph191811317] [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: 06/06/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
Young people living with perinatal infections of Human Immunodeficiency Virus (YLPHIV) face a chronic disease, with treatment including adherence to lifelong antiretroviral treatment (ART). The aim of this QES was to explore adherence to ART for YLPHIV as an assemblage within the framework of the biopsychosocial model with a new materialist perspective. We searched up to November 2021 and followed the ENTREQ and Cochrane guidelines for QES. All screening, data extraction, and critical appraisal were done in duplicate. We analysed and interpreted the findings innovatively by creating images of meaning, a storyboard, and storylines. We then reported the findings in a first-person narrative story. We included 47 studies and identified 9 storylines. We found that treatment adherence has less to do with humans' preferences, motivations, needs, and dispositions and more to do with how bodies, viruses, things, ideas, institutions, environments, social processes, and social structures assemble. This QES highlights that adherence to ART for YLPHIV is a multisensorial experience in a multi-agentic world. Future research into rethinking the linear and casual inferences we are accustomed to in evidence-based health care is needed if we are to adopt multidisciplinary approaches to address pressing issues such as adherence to ART.
Collapse
Affiliation(s)
- Lynn A. Hendricks
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town 3000, South Africa
- Research Group SoMeTHin’K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social Sciences, Katholieke Universiteit, 3000 Leuven, Belgium
| | - Taryn Young
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town 3000, South Africa
| | - Susanna S. Van Wyk
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town 3000, South Africa
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit, 3000 Leuven, Belgium
| | - Karin Hannes
- Research Group SoMeTHin’K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social Sciences, Katholieke Universiteit, 3000 Leuven, Belgium
| |
Collapse
|
11
|
Karugaba G, Thupayagale-Tshweneagae G, Moleki MM, Mabikwa OV, Matshaba M. Determinants of health-related quality of life in young adults living with perinatally acquired HIV infection in Botswana. South Afr J HIV Med 2022; 23:1362. [PMID: 35706544 PMCID: PMC9082278 DOI: 10.4102/sajhivmed.v23i1.1362] [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: 12/17/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022] Open
Abstract
Background Due to the successful antiretroviral therapy (ART) programme in Botswana, large numbers of perinatally HIV-infected adolescents are emerging into young adulthood. Young adulthood is a critical period of human development. However, there is lack of information on the factors affecting the health-related quality of life (HRQOL) of young adults living with perinatally acquired HIV (YALPH) in Botswana. Objectives The objective of this study was to assess the HRQOL and its determinants among YALPH who were enrolled on ART at Botswana-Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana. Method A cross-sectional study assessed the HRQOL of 509 YALPH aged 18–30 years using the WHOQOL-HIV BREF. Data about other variables of interest were abstracted from medical records. Bivariate analyses were performed using t and Chi-square tests to determine the associations between demographic and clinical variables and general HRQOL. The variables that were associated with the general HRQOL at P-value < 0.1 were included in the multivariable analysis using the logistic regression approach. Results The majority of participants had good general HRQOL (78.4%). The highest mean HRQOL score was in the Physical domain (5.4 [± 2.9]) and the lowest in the Environment domain (13.8 [± 2.7]). The factors that were significantly associated with the general HRQOL included: level of education attained (P = 0.012), employment status (P = 0.069), viral load suppression (P = 0.073) and self-reported illness (P = 0.001). Conclusion Interventions that effectively increase educational attainment, employment opportunities, ART adherence, and prevention or management of illness are needed to promote good HRQOL among YALPH in Botswana.
Collapse
Affiliation(s)
- Grace Karugaba
- Department of Health Studies, University of South Africa, Pretoria, South Africa
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | | | - Mary M. Moleki
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Onkabetse V. Mabikwa
- Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Palapye, Botswana
| | - Mogomotsi Matshaba
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
- Baylor College of Medicine, Houston, Texas, United States of America
| |
Collapse
|
12
|
Dow DE, Mmbaga BT, Gallis JA, Turner EL, Gandhi M, Cunningham CK, O'Donnell KE. A group-based mental health intervention for young people living with HIV in Tanzania: results of a pilot individually randomized group treatment trial. BMC Public Health 2020; 20:1358. [PMID: 32887558 PMCID: PMC7487650 DOI: 10.1186/s12889-020-09380-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Increasing numbers of young people living with HIV (YPLWH) have unaddressed mental health challenges. Such challenges are associated with poor antiretroviral therapy (ART) adherence and high mortality. Few evidence-based mental health interventions exist to improve HIV outcomes among YPLWH. METHODS This pilot group treatment trial individually randomized YPLWH from two clinical sites in Tanzania, evaluated acceptability, feasibility, and preliminary effectiveness of a mental health intervention, Sauti ya Vijana (SYV; The Voice of Youth), was compared to the local standard-of-care (SOC) for improving ART adherence and virologic suppression. Enrolled YPLWH were 12-24 years of age and responded to mental health and stigma questionnaires, self-reported adherence, objective adherence measures (ART concentration in hair), and HIV RNA at baseline and 6-months (post-intervention). Feasibility and acceptability were evaluated, and potential effectiveness was assessed by comparing outcomes between arms using mixed effects modeling. RESULTS Between June 2016 and July 2017, 128 YPLWH enrolled; 105 were randomized and 93 (55 in SYV) followed-up at 6-months and were thereby included in this analysis. Mean age was 18.1 years; 51% were female; and 84% were HIV-infected perinatally. Attendance to intervention sessions was 86%; 6-month follow-up was 88%, and fidelity to the protocol approached 100%. Exploratory analyses of effectiveness demonstrated self-reported adherence improved by 7.3 percentage points (95% CI: 2.2, 12.3); and the pooled standard deviation for all ART concentration values increased by 0.17 units (95% CI: - 0.52, 0.85) in the SYV arm compared to SOC. Virologic suppression rates (HIV RNA < 400 copies/mL) at baseline were 65% in both arms but increased to 75% in the SYV arm while staying the same in the SOC arm (RR 1.13; 95% CI: 0.94, 1.36). CONCLUSIONS YPLWH often have poor HIV outcomes, making interventions to improve outcomes in this population critical. This pilot trial of the Tanzania-based SYV intervention demonstrated trends towards improvement in ART adherence and virologic outcomes among YPLWH, supporting efforts to scale the intervention into a fully-powered effectiveness trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02888288 . Registered August 9, 2016. Retrospectively registered as first participant enrolled June 16, 2016.
Collapse
Affiliation(s)
- Dorothy E Dow
- Duke University Medical Center, Pediatrics, Infectious Diseases, Box 3499, Durham, NC, 27710, USA. .,Duke Global Health Institute, Durham, NC, USA. .,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
| | - Blandina T Mmbaga
- Duke Global Health Institute, Durham, NC, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - John A Gallis
- Duke Global Health Institute, Durham, NC, USA.,Duke University, Department of Biostatistics and Bioinformatics, Durham, NC, USA
| | - Elizabeth L Turner
- Duke Global Health Institute, Durham, NC, USA.,Duke University, Department of Biostatistics and Bioinformatics, Durham, NC, USA
| | | | - Coleen K Cunningham
- Duke University Medical Center, Pediatrics, Infectious Diseases, Box 3499, Durham, NC, 27710, USA.,Duke Global Health Institute, Durham, NC, USA
| | - Karen E O'Donnell
- Duke University, Center for Health Policy and Inequalities Research, Durham, NC, USA.,Center for Child and Family Health, Durham, NC, USA
| |
Collapse
|
13
|
Nonadherence and unsuppressed viral load across adolescence among US youth with perinatally acquired HIV. AIDS 2019; 33:1923-1934. [PMID: 31274538 DOI: 10.1097/qad.0000000000002301] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify factors associated with nonadherence and unsuppressed viral load across adolescence among youth with perinatally acquired HIV. DESIGN Longitudinal study at 15 US clinical sites. METHODS Self-reported antiretroviral medication nonadherence (any missed dose, past week) and unsuppressed viral load (HIV RNA > 400 copies/ml) were assessed annually. Individual, caregiver, social, and structural factors associated with nonadherence and unsuppressed viral load were identified by age (years): 8-11 (preadolescence), 12-14 (early adolescence), 15-17 (middle adolescence), and 18-22 (late adolescence/young adulthood), utilizing multivariable generalized linear mixed effects models. RESULTS During a median 3.3-year follow-up, 381 youth with perinatally acquired HIV contributed viral load measurements and 379 completed 1190 adherence evaluations. From preadolescence to late adolescence/young adulthood, prevalence of nonadherence increased from 31 to 50% (P < 0.001); prevalence of unsuppressed viral load increased from 16 to 40% (P < 0.001). In adjusted analyses, in pre, middle, and late adolescence/young adulthood, perceived antiretroviral side effects were associated with nonadherence. Additional factors associated with nonadherence included: in preadolescence, using a buddy system (as an adherence reminder); in early adolescence, identifying as black, using buddy system; in middle adolescence, CD4% less than 15%, unmarried caregiver, indirect exposure to violence, stigma/fear of inadvertent disclosure, stressful life events. Associations with unsuppressed viral load included: in early adolescence, youth unawareness of HIV status, lower income; in middle adolescence, perceived antiretroviral side effects, lower income; in late adolescence/young adulthood, distressing physical symptoms, and perceived antiretroviral side effects. CONCLUSION Prevalence of nonadherence and unsuppressed viral load increased with age. Associated factors varied across adolescence. Recognition of age-specific factors is important when considering strategies to support adherence.
Collapse
|
14
|
The global epidemiology of adolescents living with HIV: time for more granular data to improve adolescent health outcomes. Curr Opin HIV AIDS 2019; 13:170-178. [PMID: 29432227 DOI: 10.1097/coh.0000000000000449] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize recent evidence on the global epidemiology of adolescents (age 10-19 years) living with HIV (ALHIV), the burden of HIV on the health of adolescents and HIV-associated mortality. RECENT FINDINGS In 2016, there were an estimated 2.1 million (uncertainty bound 1.4-2.7 million) ALHIV; 770 000 younger (age 10-14 years) and 1.03 million older (age 15-19 years) ALHIV, 84% living in sub-Saharan Africa. The population of ALHIV is increasing, as more peri/postnatally infected ALHIV survive into older ages; an estimated 35% of older female ALHIV were peri/postnatally infected, compared with 57% of older male ALHIV. Although the numbers of younger ALHIV deaths are declining, deaths among older ALHIV have remained static since peaking in 2012. In 2015, HIV-associated mortality was the eighth leading cause of adolescent death globally and the fourth leading cause in African low and middle-income countries. SUMMARY Needed investments into characterizing and improving adolescent HIV-related health outcomes include strengthening systems for nationally and globally disaggregated data by age, sex and mode of infection; collecting more granular data within routine programmes to identify structural, social and mental health challenges to accessing testing and care; and prioritizing viral load monitoring and adolescent-focused differentiated models of care.
Collapse
|
15
|
Enane LA, Mokete K, Joel D, Daimari R, Tshume O, Anabwani G, Mazhani L, Steenhoff AP, Lowenthal ED. "We did not know what was wrong"-Barriers along the care cascade among hospitalized adolescents with HIV in Gaborone, Botswana. PLoS One 2018; 13:e0195372. [PMID: 29630654 PMCID: PMC5890999 DOI: 10.1371/journal.pone.0195372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 03/21/2018] [Indexed: 12/19/2022] Open
Abstract
High mortality among adolescents with HIV reflects delays and failures in the care cascade. We sought to elucidate critical missed opportunities and barriers to care among adolescents hospitalized with HIV at Botswana's tertiary referral hospital. We enrolled all HIV-infected adolescents (aged 10-19 years) hospitalized with any diagnosis other than pregnancy from July 2015 to January 2016. Medical records were reviewed for clinical variables and past engagement in care. Semi-structured interviews of the adolescents (when feasible) and their caregivers explored delays and barriers to care. Twenty-one eligible adolescents were identified and 15 were enrolled. All but one were WHO Clinical Stage 3 or 4. Barriers to diagnosis included lack of awareness about perinatal HIV infection, illness or death of the mother, and fear of discrimination. Barriers to adherence to antiretroviral therapy included nondisclosure, isolation, and mental health concerns. The number of hospitalized HIV-infected adolescents was lower than expected. However, among those hospitalized, the lack of timely diagnosis and subsequent gaps in the care cascade elucidated opportunities to improve outcomes and quality of life for this vulnerable group.
Collapse
Affiliation(s)
- Leslie A. Enane
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Botswana-UPenn Partnership, Gaborone, Botswana
- * E-mail:
| | - Keboletse Mokete
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Dipesalema Joel
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Rahul Daimari
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Ontibile Tshume
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Gabriel Anabwani
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Loeto Mazhani
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Andrew P. Steenhoff
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Botswana-UPenn Partnership, Gaborone, Botswana
- Center for Global Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth D. Lowenthal
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Botswana-UPenn Partnership, Gaborone, Botswana
- Center for Global Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
16
|
Prasitsuebsai W, Sethaputra C, Lumbiganon P, Hansudewechakul R, Chokephaibulkit K, Truong KH, Nguyen LV, Mohd Razali KA, Nik Yusoff NK, Fong MS, Teeraananchai S, Ananworanich J, Durier N. Adherence to antiretroviral therapy, stigma and behavioral risk factors in HIV-infected adolescents in Asia. AIDS Care 2018; 30:727-733. [PMID: 29336591 DOI: 10.1080/09540121.2018.1425363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We studied behavioral risks among HIV-infected and uninfected adolescents using an audio computer-assisted self-interview. A prospective cohort study was initiated between 2013 and 2014 in Malaysia, Thailand, and Vietnam. HIV-infected adolescents were matched to uninfected adolescents (4:1) by sex and age group (12-14 and 15-18 years). We enrolled 250 HIV-infected (48% male; median age 14.5 years; 93% perinatally infected) and 59 uninfected (51% male; median age 14.1 years) adolescents. At enrollment, HIV-infected adolescents were on antiretroviral therapy (ART) for a median (IQR) of 7.5 (4.7-10.2) years, and 14% had HIV-RNA >1000 copies/mL; 19% reported adherence <80%. Eighty-four (34%) HIV-infected and 26 (44%) uninfected adolescents reported having ever smoked cigarettes or drunk alcohol (p = 0.13); 10% of HIV-infected and 17% of uninfected adolescents reported having initiated sexual activity; 6 of the HIV-infected adolescents had HIV-RNA >1000 copies/mL. Risk behaviors were common among adolescents, with few differences between those with and without HIV.
Collapse
Affiliation(s)
- Wasana Prasitsuebsai
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | | | - Pagakrong Lumbiganon
- c Faculty of Medicine , Srinagarind Hospital, Khon Kaen University , Khon Kaen , Thailand
| | | | | | | | | | | | | | | | - Sirinya Teeraananchai
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Jintanat Ananworanich
- k US Military HIV Research Program , Walter Reed Army Institute of Research , Silver Spring , USA.,l Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , USA.,m SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,n University of Amsterdam , Amsterdam , the Netherlands
| | - Nicolas Durier
- b TREAT Asia/amfAR-The Foundation for AIDS Research , Bangkok , Thailand.,o Dreamlopments LTD , Bangkok , Thailand
| | | |
Collapse
|