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Brathwaite R, Mutumba M, Nannono S, Ssewamala FM, Filiatreau LM, Namatovu P. Prevalence and Correlates of Substance Use Among Youth Living with HIV in Fishing Communities in Uganda. AIDS Behav 2024; 28:2414-2426. [PMID: 38605252 DOI: 10.1007/s10461-024-04339-6] [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: 04/03/2024] [Indexed: 04/13/2024]
Abstract
Alcohol and drug use (ADU) poses a significant barrier to optimal HIV treatment outcomes for adolescents and youths living with HIV (AYLHIV). We aimed to investigate the prevalence and correlates of ADU among ALHIV in Ugandan fishing communities, areas characterized by high HIV and poverty rates. AYLHIV aged 18-24, who knew they were HIV-positive, were selected from six HIV clinics. Substance use was determined through self-report in the last 12 months and urine tests for illicit substances. Utilizing a socioecological framework, the study structured variables into a hierarchical logistic regression analysis to understand the multi-layered factors influencing ADU. Self-reported past 12 months substance use was 42%, and 18.5% of participants had a positive urine test for one or more substances, with alcohol, benzodiazepines, and marijuana being the most commonly used. With the addition of individual-level socio-demographics, indicators of mental health functioning, interpersonal relationships, and community factors, the logistic regression analysis revealed greater exposure to adverse childhood experiences increased the odds of substance use (Odds Ratio [OR] = 1.24; 95% Confidence Interval [CI]: 1.03-1.55). Additionally, exposure to alcohol advertisements at community events significantly raised the odds of substance use (OR = 3.55; 95% CI: 1.43-8.83). The results underscore the high prevalence among AYLHIV and emphasize the need for comprehensive interventions targeting individual (e.g., life skills education and mental health supports), interpersonal (e.g., peer support and family-based interventions), community (e.g., community engagement programs, restricted alcohol advertisements and illicit drug access), and policies (e.g., integrated care models and a national drug use strategy), to address ADU.
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Affiliation(s)
- Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
| | - Massy Mutumba
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building Ann Arbor, MI, 48109-5482, USA
| | - Sylvia Nannono
- 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
| | - Lindsey M Filiatreau
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Phionah Namatovu
- International Center for Child Health and Development, Masaka, Uganda
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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.
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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
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Brathwaite R, Mutumba M, Nanteza J, Filiatreau LM, Migadde H, Namatovu P, Nabisere B, Mugisha J, Mwebembezi A, Ssewamala FM. Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46486. [PMID: 37314844 PMCID: PMC10337321 DOI: 10.2196/46486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them. OBJECTIVE We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda's fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them. METHODS This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group). RESULTS Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024. CONCLUSIONS Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them. TRIAL REGISTRATION ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46486.
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Affiliation(s)
- Rachel Brathwaite
- Brown School, Washington University in St. Louis, St Louis, MO, United States
| | - Massy Mutumba
- Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Herbert Migadde
- International Center for Child Health and Development, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, Masaka, Uganda
| | - Betina Nabisere
- International Center for Child Health and Development, Masaka, Uganda
| | | | | | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St Louis, MO, United States
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Louthrenoo O, Aurpibul L, Oberdorfer P, Sirisanthana V. Family Functioning in Adolescents with Perinatal HIV Infection. J Int Assoc Provid AIDS Care 2019; 17:2325958218774782. [PMID: 29756549 PMCID: PMC6748494 DOI: 10.1177/2325958218774782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study aimed to assess family functioning in adolescents with perinatal HIV infection receiving antiretroviral therapy compared with healthy controls. Correlations between self-reported and caregiver-reported family functions were also evaluated. A sample of 195 participants including 65 perinatally HIV-infected adolescents and 130 healthy controls were enrolled. The total family functioning score in HIV-infected adolescents was significantly lower than that in healthy controls by self-report (105.86 vs 115.41; P ≤ .001). Caregivers of HIV-infected adolescents also reported lower scores of family functioning than those of controls (109.91 vs 114.98; P ≤ .001). Among the HIV-infected group, there was no or minimal correlation between the self-reported and caregiver-reported total scores of family functioning. However, there were moderate correlations between self-reported and caregiver-reported family functioning total scores in the control group. Overall, HIV-infected adolescents reported lower family functioning than healthy controls. Improved functioning in the family may help with better adjustment in perinatally HIV-infected adolescents.
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Affiliation(s)
- Orawan Louthrenoo
- 1 Department of Pediatrics, Chiang Mai University, Chiang Mai, Thailand
| | - Linda Aurpibul
- 2 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Virat Sirisanthana
- 2 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Webster KD, de Bruyn MM, Zalwango SK, Sikorskii A, Barkin JL, Familiar-Lopez I, Musoke P, Giordani B, Boivin MJ, Ezeamama AE. Caregiver socioemotional health as a determinant of child well-being in school-aged and adolescent Ugandan children with and without perinatal HIV exposure. Trop Med Int Health 2019; 24:608-619. [PMID: 30809898 DOI: 10.1111/tmi.13221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Caregiver socio-emotional attributes are major determinants of child well-being. This investigation in vulnerable school-aged Ugandan children estimates relationships between children's well-being and their caregiver's anxiety, depression and social support. METHODS Perinatally HIV-infected, HIV-exposed uninfected and HIV-unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18 months of age using DNA-polymerase chain-reaction test; status was confirmed via HIV rapid diagnostic test when children were 6-18 years old. Five indicators of child well-being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers' socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (β) and corresponding 95% confidence intervals (CI) for child well-being in relation to caregiver's psychosocial status. RESULTS As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95%CI:0.2%, 5.3%) and lower self-esteem/QOL (β = -1.3%/-2.6%; 95%CI: -5.0%,-0.2%) in their children. Child distress/hopelessness increased (β = 3.3%/7.6%; 95%CI:0.4%, 14.7%) and self-esteem/QOL decreased 2.3% (β = -2.3%/-4.4%; 95%CI: -7.2%, -1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (β = 3%; 95%CI:1.4%, 4.5%) in their children. HIV-infected/exposed children had most caregiver depression-related QOL deficit (β = -5.2%/-6.8%; 95%CI: -12.4%, -0.2%) and HIV-unexposed children had most caregiver social support-related enhancements in positive outlook (β=4.5%; 95%CI:1.9%, 7.1%). CONCLUSIONS Caregiver anxiety, depressive symptoms and low social support were associated with worse well-being in school-aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well-being of vulnerable children and adolescents in this setting.
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Affiliation(s)
- Kyle D Webster
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Miko M de Bruyn
- Department of Epidemiology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Sarah K Zalwango
- Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jennifer L Barkin
- Department of Community Medicine and Ob/Gyn, Mercer University School of Medicine, Mercer University, Macon, GA, USA
| | - Itziar Familiar-Lopez
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bruno Giordani
- Departments of Psychiatry, Neurology, and Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Boivin
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Amara E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
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Gentz SG, Calonge-Romano I, Martínez-Arias R, Zeng C, Ruiz-Casares M. Mental health among adolescents living with HIV in Namibia: the role of poverty, orphanhood and social support. AIDS Care 2018; 30:83-91. [PMID: 29848003 DOI: 10.1080/09540121.2018.1469727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The mental health needs of children and adolescents living with HIV (ALHIV) in Namibia are poorly understood, despite the dramatic improvement in their survival. ALHIV in resource poor contexts face particular risk factors, such as poverty, orphanhood, and poor social support. This study examines the mental health of ALHIV in Namibia, and the factors that contribute to mental health problems. A case-control design assessed emotional and behavioural symptoms of distress, risk and protective factors among adolescents aged 12-18 years. Case participants were 99 HIV-positive adolescents. Case controls were 159 adolescents from the same community who were not known to be HIV seropositive at the time of the study. Control group participants were selected from schools using a stratified random sampling. A larger proportion of HIV-positive adolescents were orphaned (62.6% vs. 20.8%, p < .001); the groups showed no differences in poverty factors. HIV-positive adolescents scored lower than the control group on total perceived social support (p < .05) and caregiver support (p < .05), but no differences in perceived friend support and support from a self-selected person were present. HIV-positive adolescents reported significantly more total emotional and behavioural difficulties (p = .027) and conduct problems (p = .025), even after controlling for socio-demographic factors. However, after controlling for the effects of orphanhood, group differences in mental health outcomes were no longer significant. Furthermore, mediation analysis suggested that social support completely mediated the relationship between HIV status and mental health (standardised pathway coefficients = .05, p = .021). Policies and programmes that aim to strengthen social support and take orphanhood status into consideration may improve the mental health of adolescents living with HIV.
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Affiliation(s)
- Shelene G Gentz
- a Human Sciences Department , University of Namibia , Windhoek , Namibia.,b Facultad de Psicología , Universidad Complutense de Madrid , Madrid , Spain
| | | | | | - Chengbo Zeng
- c Department of Biostatistics and Epidemiology, School of Public Health , Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Mónica Ruiz-Casares
- d Division of Social and Cultural Psychiatry , McGill University , Montreal , Canada
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Xu L, Munir K, Kanabkaew C, Le Coeur S. Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand. PLoS One 2017; 12:e0172392. [PMID: 28207891 PMCID: PMC5312953 DOI: 10.1371/journal.pone.0172392] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/03/2017] [Indexed: 11/23/2022] Open
Abstract
Background Existing studies have suggested decreased adherence and rebound in mortality in perinatally HIV-infected adolescents receiving antiretroviral therapy (ART) as compared to adults and young children. Methods We used both quantitative and qualitative approaches to identify factors influencing adherence among perinatally infected adolescents in Thailand. We analyzed data from 568 pairs of perinatally infected adolescents (aged 12–19) and their primary caregivers in the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional survey conducted in 2010–2012. We also conducted 12 in-depth interviews in 2014 with infected adolescents or their primary caregivers to elicit experiences of living with long-term ART. Results From the quantitative analysis, a total of 275 (48.4%) adolescents had evidence of suboptimal adherence based on this composite outcome: adolescents self-reported missing doses in the past 7 days, caregiver rating of overall adherence as suboptimal, or latest HIV-RNA viral load ≥1000 copies/ml. In multivariate logistic regression analysis, younger age, having grandparents or extended family members as the primary caregiver, caregiver-assessed poor intellectual ability, having a boy/girlfriend, frequent online chatting, self-reported unhappiness and easiness in asking doctors questions were significantly associated with suboptimal adherence. From the in-depth interviews, tensed relationships with caregivers, forgetfulness due to busy schedules, and fear of disclosing HIV status to others, especially boy/girlfriends, were important contributors to suboptimal adherence. Social and emotional support and counseling from peer group was consistently reported as a strong adherence-promoting factor. Conclusion Our findings highlight unique barriers of ART adherence among the perinatally infected adolescents. Future interventions should be targeted at helping adolescents to improve interpersonal relationships and build adaptive skills in recognizing and addressing challenging situations related to ART taking.
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Affiliation(s)
- Luyi Xu
- Harvard Medical School, Boston, United States of America
- * E-mail:
| | - Kerim Munir
- Harvard Medical School, Boston, United States of America
- Developmental Medicine Center, Division of Developmental Medicine, Boston Children's Hospital, Boston, United States of America
| | - Cheeraya Kanabkaew
- Institut de recherche pour le développement (IRD) 174-PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) 174-PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d’Etudes Démographiques (INED), Paris, France
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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8
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Bennett DS, Hersh J, Herres J, Foster J. HIV-Related Stigma, Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV? Child Psychiatry Hum Dev 2016; 47:657-64. [PMID: 26458909 DOI: 10.1007/s10578-015-0599-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.
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Affiliation(s)
- David S Bennett
- Department of Psychiatry, GLAD Program, Drexel University, 4700 Wissahickon Avenue, Philadelphia, PA, 19144, USA.
| | - Jill Hersh
- Psychology Department, Immaculata University, Immaculata, PA, USA
| | - Joanna Herres
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Jill Foster
- Government Affairs, Gilead Sciences Inc., Philadelphia, PA, USA
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9
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Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children - a Retrospective Cohort Study. J Int AIDS Soc 2016; 19:20694. [PMID: 27341885 PMCID: PMC4920943 DOI: 10.7448/ias.19.1.20694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022] Open
Abstract
Objective To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA) between 6 and 18 years of life (i.e. during school-age and adolescence). Methods We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem) were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β) in PA indicators and corresponding 95% confidence intervals (CIs). Results During school-age and adolescence, positive outlook (β=−3.8, 95% CI: −7.2, −0.1) and self-esteem (β=−4.3, 95% CI: −6.7, −1.8) scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5) and distress (β=12.3, 95% CI: 5.9, 18.7) symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=−4.3, 95% CI: −7.3, −1.2) and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children. Conclusions Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure) predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected children may improve PA and quality of life in these vulnerable groups.
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10
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Abubakar A, Van de Vijver FJR, Fischer R, Hassan AS, K Gona J, Dzombo JT, Bomu G, Katana K, Newton CR. 'Everyone has a secret they keep close to their hearts': challenges faced by adolescents living with HIV infection at the Kenyan coast. BMC Public Health 2016; 16:197. [PMID: 26927422 PMCID: PMC4772469 DOI: 10.1186/s12889-016-2854-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 02/10/2016] [Indexed: 12/18/2022] Open
Abstract
Background The upsurge in the uptake of antiretroviral therapy (ART) has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast. Methods A total of 44 participants (12 HIV-infected adolescents, 7 HIV uninfected adolescents, and 25 key informants) took part in this qualitative study, using individually administered in-depth interviews. A framework approach was used to analyze the data using NVIVO software. Results We observed that the challenges faced by adolescents in rural Kenya could be placed into six major themes: poverty, poor mental and physical health, the lack of a school system that is responsive to their needs, challenges in how to disclose to peers and family members, high levels of stigma in its various forms, and challenges of medical adherence leading to the need for close monitoring. Conclusion In this African community, vertically acquired HIV-infected adolescents face a complex set of social, economic and medical challenges. Our study points to the urgent need to develop multisectorial intervention support programmes to fully address these challenges. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2854-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amina Abubakar
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya. .,Tilburg University, Tilburg, Netherlands. .,Lancaster University, Lancaster, UK.
| | - Fons J R Van de Vijver
- Tilburg University, Tilburg, Netherlands.,North-West University, Potchefstroom, South Africa.,University of Queensland, Brisbane, Australia
| | - Ronald Fischer
- Victoria University of Wellington, Wellington, New Zealand.,Aarhus University, Aarhus, Denmark
| | - Amin S Hassan
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Joseph K Gona
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Judith Tumaini Dzombo
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Grace Bomu
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Khamis Katana
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Charles R Newton
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya.,University of Oxford, Oxford, UK
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Geibel S, Habtamu K, Mekonnen G, Jani N, Kay L, Shibru J, Bedilu L, Kalibala S. Reliability and Validity of an Interviewer-Administered Adaptation of the Youth Self-Report for Mental Health Screening of Vulnerable Young People in Ethiopia. PLoS One 2016; 11:e0147267. [PMID: 26863626 PMCID: PMC4749233 DOI: 10.1371/journal.pone.0147267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 12/31/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Evaluate the reliability and validity of the Youth Self-Report (YSR) as a screening tool for mental health problems among young people vulnerable to HIV in Ethiopia. DESIGN A cross-sectional assessment of young people currently receiving social services. METHODS Young people age 15-18 participated in a study where a translated and adapted version of the YSR was administered by trained nurses, followed by an assessment by Ethiopian psychiatrists. Internal reliability of YSR syndrome scales were assessed using Chronbach's alpha. Test-retest reliability was assessed through repeating the YSR one month later. To assess validity, analysis of the sensitivity and specificity of the YSR compared to the psychiatrist assessment was conducted. RESULTS Across the eight syndrome scales, the YSR best measured the diagnosis of anxiety/depression and social problems among young women, and attention problems among young men. Among individual YSR syndrome scales, internal reliability ranged from unacceptable (Chronback's alpha = 0.11, rule-breaking behavior among young women) to good (α≥0.71, anxiety/depression among young women). Anxiety/depression scores of ≥8.5 among young women also had good sensitivity (0.833) and specificity (0.754) to predict a true diagnosis. The YSR syndrome scales for social problems among young women and attention problems among young men also had fair consistency and validity measurements. Most YSR scores had significant positive correlations between baseline and post-one month administration. Measures of reliability and validity for most other YSR syndrome scales were fair to poor. CONCLUSIONS The adapted, personally administered, Amharic version of the YSR has sufficient reliability and validity in identifying young vulnerable women with anxiety/depression and/or social problems, and young men with attention problems; which were the most common mental health disorders observed by psychiatrists among the migrant populations in this study. Further assessment of the applicability of the YSR among vulnerable young people for less common disorders in Ethiopia is needed.
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Affiliation(s)
- Scott Geibel
- Population Council, Washington, DC, United States of America
| | - Kassahun Habtamu
- School of Psychology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Nrupa Jani
- Population Council, Washington, DC, United States of America
| | | | | | - Lake Bedilu
- Department of Psychology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Samuel Kalibala
- Population Council, Washington, DC, United States of America
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Louw KA, Ipser J, Phillips N, Hoare J. Correlates of emotional and behavioural problems in children with perinatally acquired HIV in Cape Town, South Africa. AIDS Care 2016; 28:842-50. [PMID: 26846545 DOI: 10.1080/09540121.2016.1140892] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the antiretroviral era, youth perinatally infected with HIV (PHIV+) are surviving into adulthood and are at risk for emotional and behavioural problems. Few studies of these problems have been conducted in low- and middle-income countries and even fewer in sub-Saharan Africa. The aims of this study were to provide a quantitative description of emotional and behavioural problems in a group of PHIV+ youth (n = 78) in South Africa compared with a group of demographically matched HIV-negative controls (n = 30) and to identify correlates of emotional and behavioural problems. A cross-sectional study was conducted employing participants from community and hospital-based clinics. Emotional and behavioural problems were assessed using the Child Behaviour Checklist (CBCL). Several measures were used to assess demographic, biological, cognitive and contextual correlates of problem behaviours. Youth were compared by HIV status on demographic, cognitive and contextual variables as well as the Total Problems and subscale scores of the CBCL. Multivariate comparisons of the influence of contextual and cognitive variables on CBCL Total Problems scores were performed using a stepwise linear regression analytic procedure. In this study, there were no significant differences in between-group comparisons for the prevalence of Internalizing, Externalizing and Total Problems in the PHIV+ youth and control group at the clinical and borderline cut-off ranges of the CBCL. Caregiver depression was the only significant predictor of greater Total Problems scores in the full model, after controlling for age and gender (F = 8.57, df = 5.102, P < .01). An interaction between HIV status and caregiver depression was observed (t = -2.20, P = .03), with follow-up within-group analyses confirming that caregiver depression predicted greater Total Problems scores both in HIV-negative youth (β = 0.61, P < .001), and to a lesser extent, in HIV-positive youth (β = 0.25, P < .001). This study highlights the need for adequate screening of depression in the caregivers of HIV-infected youth.
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Affiliation(s)
- Kerry-Ann Louw
- a Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Jonathan Ipser
- a Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Nicole Phillips
- a Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Jacqueline Hoare
- a Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
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Prevalence and Correlates of HIV Disclosure Among Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review. J Dev Behav Pediatr 2016; 37:496-505. [PMID: 27262128 PMCID: PMC5949066 DOI: 10.1097/dbp.0000000000000303] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Disclosure of HIV status among children and adolescents living with HIV has both beneficial and challenging aspects. To address existing knowledge gaps and update the literature on childhood disclosure, we conducted a systematic review on caregivers' perceptions and practices of HIV disclosure in low- and middle-income countries (LMICs). METHODS Standard databases were searched for studies conducted in LMICs, published in English between 2004 and 2015. Excluded articles were reviews or case reports, and those not reporting childhood disclosure. Data regarding prevalence, correlates and impact of disclosure, were presented as frequencies. RESULTS Two authors independently screened 982 articles. After applying eligibility criteria, 22 articles representing 12 countries and 2,843 children were reviewed. The proportion of fully disclosed children ranged from 1.7% to 41.0%. Up to 49.5% children were provided "deflected" information (use of a non-HIV-related reason for explaining illness and health care visits). Factors associated with full disclosure included antiretroviral treatment initiation and caregivers' felt need for maintaining optimal adherence. Barriers to disclosure included fear of negative psychological reactions and inadvertent disclosure to others. Caregivers perceived a strong need for active participation from health care providers to aid the process of disclosure. CONCLUSIONS Full disclosure of HIV status was not common among children and adolescents in LMICs, while the practice of deflected disclosure was prominent. Caregivers perceived the need for support from health care providers during the disclosure process. Evidence-based guidelines incorporating the developmental status of the child, locally prevalent cultures, and caregiver perceptions are prerequisite to enhancing disclosure in these settings.
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Kang E, Delzell DAP, Chhabra M, Oberdorfer P. Factors associated with high rates of antiretroviral medication adherence among youth living with perinatal HIV in Thailand. Int J STD AIDS 2014; 26:534-41. [PMID: 25080289 DOI: 10.1177/0956462414545524] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
Abstract
Antiretroviral medication adherence behaviour among Thai youth with perinatal HIV in Thailand has received growing attention. However, few studies have examined individual predictors of antiretroviral adherence using multiple self-reports. A convenience sample of 89 Thai youth (interquartile range 14-16 years) with perinatal HIV at three paediatric programmes in Chiang Mai completed a structured questionnaire and reported their antiretroviral adherence in the past one, seven and 30 days using count-based recall and a visual analog scale. Mean self-reported adherence rates ranged from 83.5% (past 30 days) to 99.8% (yesterday) of the time. One-inflated beta regression models were used to examine the associations between antiretroviral adherence outcomes, treatment self-efficacy, depression, anxiety, social support and beliefs/attitudes about medications. Higher percentage of medications taken in the past 30 days was independently associated with higher treatment self-efficacy and fewer symptoms of depression. Adherence monitoring would benefit from focal assessment of youth depression and perceived capacity to follow their antiretroviral regimen.
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Affiliation(s)
- Ezer Kang
- Department of Psychology, Wheaton College, Wheaton, IL, USA
| | - Darcie A P Delzell
- Department of Mathematics and Computer Science, Wheaton College, Wheaton, IL, USA
| | - Manik Chhabra
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Peninnah Oberdorfer
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Tulloch O, Theobald S, Ananworanich J, Chasombat S, Kosalaraksa P, Jirawattanapisal T, Lakonphon S, Lumbiganon P, Taegtmeyer M. From transmission to transition: lessons learnt from the Thai paediatric antiretroviral programme. PLoS One 2014; 9:e99061. [PMID: 24893160 PMCID: PMC4043947 DOI: 10.1371/journal.pone.0099061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/28/2014] [Indexed: 12/04/2022] Open
Abstract
Background The Thai HIV programme is a leader in the public health approach to HIV treatment. Starting at transmission of HIV and ending with transition to adult services this paper assesses the paediatric HIV treatment continuum from three perspectives: service-user, provider and policy maker, to understand what works well and why. Methods A qualitative research design was used to assess and triangulate the stakeholder perspectives. Semi-structured interviews were conducted with ART service-users (n = 35), policy actors (n = 20); telephone interviews with prior caregivers of orphans (n = 10); and three focus group discussions with service-providers (hospital staff and volunteers) from a district, provincial and a university hospital. Findings Children accessing HIV care were often orphaned, cared for by elderly relatives and experiencing multiple vulnerabilities. Services were divided into three stages, 1. Diagnosis and linkage: Despite strong policies there were supply and demand-side gaps in the prevention of mother-to-child transmission ‘cascade’ preventing early diagnosis and/or treatment. 2. Maintenance on ART - Children did well on treatment; caregivers took adherence seriously and valued the quality of services. Drug resistance, adherence and psychosocial issues were important concerns from all perspectives. 3. Adolescents and transition: Adolescent service-users faced greater complexity in their physical and emotional lives for which providers lacked skills; transition from the security of paediatric clinic was a daunting prospect. Dedicated healthcare providers felt they struggled to deliver services that met service-users' diverse needs at all stages. Child- and adolescent-specific elements of HIV policy were considered low priority. Conclusions Using the notion of the continuum of care a number of strengths and weaknesses were identified. Features of paediatric services need to evolve alongside the changing needs of service users. Peer-support volunteers have potential to add continuity and support at all stages. It is critical that adolescents receive targeted support, particularly during transition to adult services.
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Affiliation(s)
- Olivia Tulloch
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jintanat Ananworanich
- SEARCH and HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sanchai Chasombat
- Bureau of AIDS, Tuberculosis and Sexually Transmitted Infections, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thidaporn Jirawattanapisal
- Bureau of AIDS, Tuberculosis and Sexually Transmitted Infections, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Sudrak Lakonphon
- SEARCH and HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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