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Sharer M, Haruzivishe C, Ndaimani A, Duffy M. 'The tablets make a certain noise': uncovering barriers and enablers related to providing PMTCT services to adolescents and young women living with HIV in Zimbabwe. HIV Res Clin Pract 2024; 25:2371174. [PMID: 38944816 DOI: 10.1080/25787489.2024.2371174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/15/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Zimbabwe antenatal HIV prevalence rate is 16.1%. HIV-positive pregnant adolescent girls and young women (AYW) are at high risk to experience perinatal mental health challenges, attributed to a combination of factors including HIV status, stigma and perinatal depression. Perinatal depression and stigma among AYW is understudied in Zimbabwe and may affect short- and long-term health of HIV positive mothers and their children, and can impact treatment adherence. METHODS Qualitative data was gathered from four focus group discussions with (2 urban and 2 rural) PMTCT providers (N = 17). Focus group discussions were also conducted among AYW clients (N = 20) from two clinics in Mashonaland East. RESULTS Qualitative analyses identified patterns related to: (1) drop out and loss to follow up, (2) retention and adherence, (3) recurring feelings of internalized stigma; and (4) acceptability of potential MH interventions. MH services are not available and AYW have limited access to adherence counseling (1-2 times at onset). Psychological support was not available at either clinic, despite both providers and clients perceiving high rates of stigma, discrimination, and challenges with disclosure. Challenges related to long waits for ART distribution and gaps in disclosure support emerged as barriers. Providers noted that AYW present as anxious (non-diagnosed), and attribute depression to those clients who are lost to follow up, stating lack of time to screen for MH related issues or actively refer them for services. Challenges related to the ability to provide strong advice and support for disclosure also emerged among providers. CONCLUSIONS This study can contribute to policy and practice recommendations to better integrate MH into HIV services and develop person-centered service models for HIV positive AYW. HIGHLIGHTSPerinatal adolescents and young women (AYW) living with HIV have gaps in retention and care in the current Zimbabwe PMTCT service model.Mental health stigma must be addressed to integrate mental health into HIV services.HIV providers are aware of the need to provide mental health support to reduce loss to follow-up.Mental health screening and referrals for services are not part of standard care for perinatal HIV positive AYW in Zimbabwe.Linkages between disclosure and AYW mental health was identified as a challenge by HIV providers.Context responsive interventions can support integration of mental health screening, services, and referrals.
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Affiliation(s)
- Melissa Sharer
- Public Health, St. Ambrose University and John Snow Research and Training Institute, Boston, MA, USA
| | | | - Augustine Ndaimani
- Nursing and Midwifery, University of Global Health Equity, Kigali, Rwanda
| | - Malia Duffy
- Health Across Humanity, LLC, Boston, MA, USA
- Department of Public Health, College of Health and Human Services, St. Ambrose University, Davenport, IA, USA
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Kabunga A, Nabasirye CK, Kigingo E, Namata H, Shikanga EM, Udho S, Auma AG, Nabaziwa J, Tumwesigye R, Musinguzi M, Okalo P, Acup W. HIV-Related Stigma Among Pregnant Adolescents: A Qualitative Study of Patient Perspectives in Southwestern Uganda. HIV AIDS (Auckl) 2024; 16:217-227. [PMID: 38770109 PMCID: PMC11104363 DOI: 10.2147/hiv.s463506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024] Open
Abstract
Background The HIV epidemic disproportionately affects adolescents in Sub-Saharan Africa, with adolescent girls facing heightened vulnerability. Despite advancements in antiretroviral therapy, HIV-related stigma remains prevalent, particularly among pregnant adolescents. This qualitative study explores the perspectives of adolescents living with HIV in southwestern Uganda, seeking to understand the nature of HIV-related stigma in this context. Methods One-on-one narrative interviews were conducted with 28 pregnant adolescents living with HIV aged 14-19 receiving care at Mbarara Regional Referral Hospital. The qualitative approach allowed for in-depth exploration of participants' experiences. Thematic analysis was employed to identify recurring patterns in the narratives. Results Five overarching themes emerged from the analysis: Experiences of double stigma, social and cultural influences shaping stigma, healthcare system challenges, psychosocial impacts of stigma, and resilience and coping mechanisms. Double stigma, arising from societal prejudices related to both HIV status and teenage pregnancy, created a complex environment for participants. Despite these challenges, participants exhibited resilience through external support and internal strength. Conclusion This study reveals the pervasive double stigma experienced by pregnant adolescents living with HIV in southwestern Uganda, driven by societal biases against both HIV status and teenage pregnancy. Urgent targeted interventions are needed to address the intersectionality of stigma, cultural influences, healthcare issues, and psychosocial well-being for the betterment of this vulnerable population.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Lira University, Lira City, Uganda
| | | | - Eustes Kigingo
- Department of Environmental Health and Disease Control, Lira University, Lira City, Uganda
| | - Halimah Namata
- Department of Mental Health, Makerere University, Kampala, Uganda
| | | | - Samson Udho
- Department of Midwifery, Lira University, Lira City, Uganda
| | | | - Jannat Nabaziwa
- Department of Community Health, Lira University, Lira City, Uganda
| | - Raymond Tumwesigye
- Department of Nursing, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Marvin Musinguzi
- Department of Community Health, Lira University, Lira City, Uganda
| | - Ponsiano Okalo
- Department of Psychiatry, Lira University, Lira City, Uganda
| | - Walter Acup
- Department of Community Health, Lira University, Lira City, Uganda
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Mabetha K, Soepnel LM, Klingberg S, Mabena G, Motlhatlhedi M, Norris SA, Draper CE. Young women's social support networks during pregnancy in Soweto, South Africa. Afr J Prim Health Care Fam Med 2024; 16:e1-e11. [PMID: 38708725 PMCID: PMC11079395 DOI: 10.4102/phcfm.v16i1.4146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Although studies from high-income countries have examined social support during pregnancy, it remains unclear what type of support is received by expectant mothers from low- and middle-income country settings. AIM To explore young women's social support networks during pregnancy in Soweto, South Africa. SETTING This study was undertaken in an academic hospital based in the Southwestern Townships (Soweto), Johannesburg, in Gauteng province, South Africa. METHODS An exploratory descriptive qualitative approach was employed. Eighteen (18) young pregnant women were recruited using a purposive sampling approach. In-depth interviews were conducted, and data were analysed using inductive thematic analysis. RESULTS Analysis of the data resulted in the development of two superordinate themes namely; (1) relationships during pregnancy and (2) network involvement. Involvement of the various social networks contributed greatly to the young women having a greater sense of potential parental efficacy and increased acceptance of their pregnancies. Pregnant women who receive sufficient social support from immediate networks have increased potential to embrace and give attention to pregnancy-related changes. CONCLUSION Focusing on less-examined characteristics that could enhance pregnant women's health could help in the reduction of deaths that arise because of pregnancy complications and contribute in globally accelerating increased accessibility to adequate reproductive health.Contribution: This study's findings emphasise the necessity for policymakers and healthcare providers to educate the broader community about the importance of partner, family and peer support to minimise risks that may affect pregnancy care and wellbeing of mothers.
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Affiliation(s)
- Khuthala Mabetha
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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4
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Laurenzi CA, Toska E, Tallarico R, Sherr L, Steventon Roberts KJ, Hansen M, Tolmay J, Jochim J, Ameyan W, Yates R. Key normative, legal, and policy considerations for supporting pregnant and postpartum adolescents in high HIV-burden settings: a critical analysis. Sex Reprod Health Matters 2023; 31:2249696. [PMID: 37712411 PMCID: PMC10506436 DOI: 10.1080/26410397.2023.2249696] [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: 09/16/2023] Open
Abstract
Rates of adolescent pregnancy within sub-Saharan Africa are increasing. Adolescent mothers ages 10-19 years face a distinct set of risks to their own and their children's health, compounded by many economic, social, and epidemiological challenges, such as living with HIV. In navigating this complex developmental period, many adolescent mothers face structural barriers impeding safe transitions to adulthood and motherhood. Drawing on existing literature and emerging data, we outline three normative, legal, and policy issues - violence and gender inequity, access to sexual and reproductive health services, and access to social and structural supports - which affect the health, wellbeing and development of adolescent mothers and their children. We also highlight emergent evidence about programming and policy changes that can better support adolescent mothers and their children. These key proposed responses include removing barriers to SRH and HIV service integration; ensuring implementation of return-to-school policies; and extending social protection systems to cater for adolescent mothers. Despite ongoing global crises and shifts in funding priorities, these normative, legal, and policy considerations remain critical to safeguard the health and wellbeing of adolescent mothers and their children.
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Affiliation(s)
- Christina A. Laurenzi
- Senior Researcher, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Elona Toska
- Associate Professor, Centre for Social Science Research, Department of Sociology, University of Cape Town, Rondebosch, South Africa; Co-director, Accelerate Hub, University of Cape Town, Rondebosch, South Africa; Associate Professor, Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom
| | - Renata Tallarico
- Youth Team Lead and SYP Regional Coordinator, United Nations Population Fund, Eastern and Southern Regional Office, Johannesburg, South Africa
| | - Lorraine Sherr
- Professor, Clinical and Health Psychology, University College London, London, United Kingdom
| | - Kathryn J. Steventon Roberts
- Postdoctoral Researcher, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Postgraduate Researcher, Institute for Global Health, University College London, London, United Kingdom
| | - Maja Hansen
- Technical Advisor, Gender Equality, United Nations Population Fund, Dar es Salaam, Tanzania
| | - Janke Tolmay
- Quantitative Research Assistant, Accelerate Hub, Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa
| | - Janina Jochim
- Postdoctoral Research Officer, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Wole Ameyan
- Technical Officer, Adolescent HIV, Global HIV Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Yates
- Strategic Advocacy Lead, Accelerate Hub, University of Oxford, Oxford, United Kingdom
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Guta NM, Ruksi ST, Gachana Midaksa Senbata, Seid K. Predictors of perceived poor social support status of pregnant women attending antiretroviral therapy clinics in south west Ethiopia, 2021. Heliyon 2023; 9:e18282. [PMID: 37519693 PMCID: PMC10372391 DOI: 10.1016/j.heliyon.2023.e18282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Background To improve pregnancy outcomes, a pregnant mother living with HIV/AIDS requires a high level of social and emotional support. However, women from low-income countries were subjected to low social support status despite adequate counseling and health messages to increase their social support. Therefore, this study aimed to investigate the predictors of the perceived poor social support status among pregnant women attending ART clinics in Southwest Ethiopia. Methods A hospital-based cross-sectional study with consecutive sampling was conducted to enroll 265 pregnant women on antiretroviral therapy (ART) from December 1 to 30, 2021. The data were collected using an interviewer-administered questionnaire. Epidata was used for data entry and analyzed after it was exported to a statistical package for the social sciences. Binary logistic regression was used and the level of significance was declared at P-value <0.05 using Adjusted odds ratio at 95% CI after candidate variables were identified in binary logistic regression at a P-value of <0.25. Results Finding from the study figured out that low level of poor social support is found to be 47.2%. Study revealed that income level[AOR = 5.1 95% CI [1.9,13.6]], disclosure status[AOR: 1.9 95% CI [1.1,3.3]], unwanted pregnancy [AOR = 2.3 CI; [ 1.4,3.9]], and low adherence level[AOR: 2.1 95% CI [1.1,3.1]] were strong predictors. Conclusion This study identified high levels of poor social support. Increasing access to information education and communications focusing on stigma, disclosure & refresher training that boosts the counseling skills of health care providers to enhance adherence level is strongly recommended.
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Affiliation(s)
- Nuredin Mohammed Guta
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Sisay Tulu Ruksi
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Gachana Midaksa Senbata
- Department of Public Health, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Kalid Seid
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
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Kesande C, Bapolisi A, Kaggwa MM, Nakimuli-Mpungu E, Maling S, Ashaba S. Prevalence and factors associated with psychological distress among pregnant and non-pregnant youth living with HIV in rural Uganda: a comparative study. PSYCHOL HEALTH MED 2023; 28:344-358. [PMID: 35260003 PMCID: PMC9458768 DOI: 10.1080/13548506.2022.2050270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/01/2022] [Indexed: 02/08/2023]
Abstract
Youth living with HIV (YLHIV) are prone to psychological distress, which may have detrimental effects on health outcomes. Pregnant youth have poor access to HIV care increasing the risk of vertical transmission of HIV to their infants. Both HIV and pregnancy are independently associated with poor mental health among adolescents. The factors that predispose women to poor mental health may also increase their risk of contracting HIV. Despite their desire to have children YLHIV are at a high risk of psychological distress. However, factors associated with psychological distress among YLHIV in rural Uganda are not well explored. Therefore, the purpose of this study was to determine the prevalence of, and factors associated with psychological distress among pregnant and non-pregnant YLHIV in south western Uganda. We enrolled 224 YLHIV aged 15-24 years both pregnant and nonpregnant (ratio 1:1) between December 2018 and March 2019. We obtained information on psychological distress and factors hypothesized to affect mental health outcomes among people living with HIV including internalized HIV stigma, intimate partner violence, self-esteem and social support. Bivariate and multivariable logistic regression analysis were used to estimate factors independently associated with psychological distress. The prevalence of psychological distress was 48.2%% among pregnant YLHIV and 32.14% among non-pregnant YLHIV. Factors significantly associated with psychological distress among pregnant YLHIV were HIV stigma (AOR=4.61; 95% CI 1.63-13.84; P=0.004), physical abuse (AOR=4.97; 95% CI 1.41- 17.56; P= 0.013), and separation from partner (AOR =0.03; 95% CI 0.001-0.580; P=0.020).
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Affiliation(s)
- Claire Kesande
- Mbarara University of science and Technology, Mbarara, Uganda
| | - Achille Bapolisi
- Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | | | | | - Samuel Maling
- Mbarara University of science and Technology, Mbarara, Uganda
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Toska E, Saal W, Chen Charles J, Wittesaele C, Langwenya N, Jochim J, Steventon Roberts KJ, Anquandah J, Banougnin BH, Laurenzi C, Sherr L, Cluver L. Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort. PLoS One 2022; 17:e0278163. [PMID: 36480550 PMCID: PMC9731463 DOI: 10.1371/journal.pone.0278163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
The Sustainable Development Goals (SDGs) are a visionary and multi-sectoral agenda for human development. With less than a decade left to reach these targets, it is important to identify those at greatest risk of not meeting these ambitious targets. Adolescent mothers and their children are a highly vulnerable group. We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Questionnaires using validated scales were completed by 10- to 24-year-old adolescent girls and young women who had their first child before age 20 in an HIV-endemic district in the Eastern Cape province of South Africa. Maternal outcomes included 26 SDG-aligned indicators, while child-related outcomes included 9 indicators. Data was collected by trained researchers, following informed voluntary consent by the adolescent mothers and their caregivers. Frequencies and chi-square tests were conducted to compare progress along SDG-aligned indicators among adolescent mothers by HIV status. Overall, adolescent mothers reported low attainment of SDG-aligned indicators. While four in five adolescent mothers lived in poor households, nearly 93% accessed at least one social cash transfer and 80% accessed a child support grant for their children. Food security rates among adolescent mothers (71%) were lower than among their children (91%). Only two-thirds of adolescent mothers returned to school after childbirth, and only one-fifth were either studying or employed. Over half of adolescent mothers had experienced at least one type of violence (domestic, sexual or community). HIV-positive status was associated with higher rates of hunger and substance use, poorer school attendance, and higher rates of exposure to violence. Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Wylene Saal
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Camille Wittesaele
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Kathryn J. Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Jason Anquandah
- Department of Statistics, University of Leeds, Leeds, United Kingdom
| | - Boladé Hamed Banougnin
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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8
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Ngocho JS, Minja LM, Mwamba RN, Knettel BA, Kisigo GA, Mmbaga BT, Watt MH. Prevalence and predictors of depression among women attending antenatal care in Moshi, Tanzania: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:594. [PMID: 35883166 PMCID: PMC9316357 DOI: 10.1186/s12884-022-04917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Antenatal depression in low-and middle-income countries is under-diagnosed and leads to poorer outcomes in the pregnancy and postpartum periods. The aim of this study was to quantify depressive symptoms among pregnant women in Moshi, Tanzania, and identify factors associated with probable depression. METHODS Between March and December 2019, we enrolled 1039 pregnant women attending their first antenatal care appointment at two government health facilities to complete an audio computer-assisted self-interview. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS), with a score > 13 indicating probable depression. A log-binomial regression model was used to identify factors associated with probable antenatal depression. RESULTS A total of 11.5% (119/1033) met criteria for probable depression. Depression was more common among women who were not married (16.5% vs. 7.9%, PrR = 1.5, 95% CI 1.0, 2.1) and women who reported a lifetime history of violence (22.6% vs. 5.3%, PrR = 3.3, 95% CI 2.2, 5.0). Depression was less common among women who reported more partner-specific support (PrR = 0.92, 95% CI 0.87, 0.96). CONCLUSIONS Screening pregnant women for depressive symptoms is an essential component of evidence-based maternity care and should be accompanied by appropriate support and resources. Women who are not married, have limited support from a partner, or have experienced violence are especially vulnerable to depressive symptomatology during pregnancy.
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Affiliation(s)
- James S Ngocho
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Brandon A Knettel
- Duke Global Health Institute, Duke University, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA
| | - Godfrey A Kisigo
- Center for Global Health, Weill Cornell Medicine, New York, NY, 10065, USA.,Mwanza Intervention Trials Unit, National Institute of Medical Research, Mwanza, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Bhushan NL, Stoner MCD, Groves AK, Kahn K, Pettifor AE. Partnership Dynamics and HIV-Related Sexual Behaviors Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data. J Adolesc Health 2022; 71:63-69. [PMID: 35370076 PMCID: PMC9232891 DOI: 10.1016/j.jadohealth.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers' partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections. METHODS Data are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13-20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence. RESULTS Adolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status. DISCUSSION Engaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW's sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term.
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Affiliation(s)
- Nivedita L Bhushan
- Center for Communication Science, RTI International, Research Triangle Park, North Carolina.
| | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, San Francisco, California
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Audrey E Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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10
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Amha H, Denekew B, Asnakew S. Depressive symptoms and associated factors among adults attending antiretroviral therapy clinic in Debre Markos comprehensive specialized hospital, Amhara, Ethiopia. SAGE Open Med 2022; 10:20503121221100992. [PMID: 35646359 PMCID: PMC9134454 DOI: 10.1177/20503121221100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to assess the prevalence and associated factors of depressive symptoms among adults attending anti-retroviral therapy follow up at Debre Markos Comprehensive Specialized Hospital. Methods Institution-based cross-sectional study was conducted, and a systematic sampling technique was used to select the 266 participants. Depressive symptoms were assessed by using patient health questionnaire 9. A binary logistic regression analysis with an odds ratio and a 95% confidence interval was used to assess the strength of associations in SPSS version 20 and a p-value < 0.05 was considered as statistically significant. Results In this study, the prevalence of depressive symptoms among HIV-positive individuals was 39.1% with 95% confidence interval (33.7%-45.3%). Multivariable analysis showed that participants who had age group > 40 (adjusted odds ratio = 5.26, 95% confidence interval (2.24-12.35)), presence of perceived stigma and discrimination (adjusted odds ratio = 7.5, 95% confidence interval = (3.77-14.9)), poor medication adherence (adjusted odds ratio = 6.05, 95% confidence interval = (2.86-12.80)), and poor social support (adjusted odds ratio = 2.53, 95% confidence interval = (1.25-5.12)) were significantly associated with depression. Conclusion The prevalence of depressive symptoms in this study was found to be significantly high. Age > 40 years old, the presence of perceived stigma and discrimination, poor medication adherence, and a lack of social support were found to be associated factors of depressive symptoms. It would be better for clinicians to give special emphasis to those patients who were stigmatized, who had compliance problems, and poor social support.
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Affiliation(s)
- Haile Amha
- Department of Nursing, College of
Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bethlehem Denekew
- Department of Nursing, College of
Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of
Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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11
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Groves AK, Bhushan NL, Stoner MCD, Gómez-Olivé FX, Kahn K, Pettifor AE. HIV and Herpes Simplex Virus Type 2 Incidence Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data. J Acquir Immune Defic Syndr 2022; 89:e23-e29. [PMID: 34855627 PMCID: PMC8837695 DOI: 10.1097/qai.0000000000002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent motherhood is common in South Africa and occurs against a backdrop of high HIV risk. While childbearing during adolescence may result in social and economic strain that may negatively impact health, there has been limited study of whether adolescent motherhood increases the risk of HIV or herpes simplex virus type 2 (HSV-2) acquisition or engagement in high-risk sexual partnerships. SETTING Data are from HIV Prevention Trials Network 068, a longitudinal conditional cash transfer study of adolescent girls and young women (age, 13-23) in rural South Africa. METHODS We used survival analysis to estimate hazard ratios to determine if adolescent motherhood (live birth before 20 years) predicted incident HIV and incident HSV-2 and generalized estimating equations for behavioral risk ratios to determine if adolescent motherhood was associated with transactional sex and age-disparate partnerships. RESULTS Of 2452 adolescent girls and young women who were HIV negative at baseline, 5% were adolescent mothers; 16% were adolescent mothers by the end of the study period. After controlling for covariates, adolescent motherhood predicted incident HSV-2 acquisition [ adjusted hazard ratios, 1.30; 95% confidence interval (CI): 1.01 to 1.95] but not HIV acquisition ( adjusted hazard ratios, 1.19; 95% CI, 0.76 to 1.86). Adolescent motherhood was also associated with being in an age-disparate partnership (adjusted risk ratio, 1.30; 95% CI: 1.07 to 1.58) but not transactional sex. CONCLUSION Adolescent motherhood increased the risk of HSV-2 and engagement in age-disparate partnerships, both known risk factors for HIV infection. Sexually transmitted infection screening and/or tailored combination HIV prevention interventions that account for the context of adolescent motherhood are critical to maximize adolescent mothers' long-term health and to meet UNAIDS 95-95-95 targets by 2030.
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Affiliation(s)
- Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA
| | | | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Francesc X Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
- INDEPTH Network, Accra, Ghana
| | - Audrey E Pettifor
- University of North Carolina at Chapel Hill, Chapel Hill, NC
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
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12
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Hair salons and stylist-client social relationships as facilitators of community-based contraceptive uptake in KwaZulu-Natal, South Africa: a qualitative analysis. Reprod Health 2021; 18:178. [PMID: 34461925 PMCID: PMC8404311 DOI: 10.1186/s12978-021-01226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa faces a high burden of unmet contraceptive need, particularly among adolescent girls and young women. Providing contraception in community-based venues may overcome barriers to contraceptive access. Our objective was to explore the potential impact of the social environment and stylist-client interactions on perceived accessibility of contraceptives within hair salons. METHODS We conducted 42 semi-structured, in-depth interviews with salon clients (100% identified as female, 100% identified as Black, median age 27.1 years) and 6 focus groups with 43 stylists (95% identified as female, 98% identified as Black, median age 29.6 years) in and around Umlazi Township, Durban, KwaZulu-Natal to explore perspectives on offering contraceptive services in hair salons. We used an inductive and deductive approach to generate the codebook, identified themes in the data, and then organized findings according to Rogers' Individual Adoption Model as applied to community-based health prevention programs. Twenty-five percent of transcripts were coded by two independent coders to ensure reliability. RESULTS We identified elements of the salon environment and stylist-client relationships as facilitators of and barriers to acceptability of salon-based contraceptive care. Factors that may facilitate perceived contraceptive accessibility in salons include: the anonymous, young, female-centered nature of salons; high trust and kinship within stylist-client interactions; and mutual investment of time. Stylists may further help clients build comprehension about contraceptives through training. Stylists and clients believe salon-based contraceptive delivery may be more accessible due to contraceptive need facilitating client buy-in for the program, as well as a salon environment in which clients may encourage other clients by voluntarily sharing their own contraceptive decisions. The non-judgmental nature of stylist-client relationships can empower clients to make contraceptive decisions, and stylists seek to support clients' continued use of contraceptives through various adherence and support strategies. Some stylists and clients identified existing social barriers (e.g. confidentiality concerns) and made recommendations to strengthen potential contraceptive delivery in salons. CONCLUSION Stylists and clients were highly receptive to contraceptive delivery in salons and identified several social facilitators as well as barriers within this setting. Hair salons are community venues with a social environment that may uniquely mitigate barriers to contraceptive access in South Africa.
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13
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Stangl AL, Mwale M, Sebany M, Mackworth-Young CR, Chiiya C, Chonta M, Clay S, Sievwright K, Bond V. Feasibility, Acceptability and Preliminary Efficacy of Tikambisane ('Let's Talk to Each Other'): A Pilot Support Group Intervention for Adolescent Girls Living With HIV in Zambia. J Int Assoc Provid AIDS Care 2021; 20:23259582211024772. [PMID: 34212766 PMCID: PMC8255553 DOI: 10.1177/23259582211024772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In Zambia, 84,959 adolescent girls and young women (AGYW) aged 15-24 are currently living with HIV. We explored the feasibility and acceptability of a 6-session, curriculum-based support group intervention designed to address key concerns of AGYW living with HIV. Setting: Urban Zambia Methods: Surveys and in-depth interviews were collected pre- and post-intervention from participants enrolled from 2 health facilities. Eight participant observations of sessions were conducted. Descriptive statistics at baseline were reported only for AGYW who participated in the intervention (N = 21), while analyses comparing baseline and endline outcome measures were restricted to participants who had data at both time points (N = 14). Results: Support groups were feasible to conduct and acceptable to participants. Co-facilitation by an adult counselor and peers living with HIV raised confidence about session content. Sessions on antiretroviral therapy (ART), disclosure and stigma, and grief and loss were most in demand. We did not observe significant differences in key outcome measures between baseline and follow-up. However, qualitative data supported the positive impact of the intervention on ART adherence and hope for the future following the intervention among our participants. Conclusion: A short-term, structured support group series holds promise for helping AGYW living with HIV safely navigate a complex time in their lives.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, Youth and Development, International Center for Research on Women, Washington DC, USA.,Hera Solutions, Owings Mills, MD, USA
| | - Mwangala Mwale
- Social Science Unit, Zambart, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia, Africa
| | - Meroji Sebany
- Department of Global Health, Youth and Development, International Center for Research on Women, Washington DC, USA
| | - Constance Rs Mackworth-Young
- Social Science Unit, Zambart, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia, Africa.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC, United Kingdom
| | | | | | - Sue Clay
- 3C Regional Consultants, Lusaka, Zambia, Africa
| | - Kirsty Sievwright
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia Bond
- Social Science Unit, Zambart, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia, Africa.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC, United Kingdom
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14
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Coleman JN, Milford C, Mosery N, Choi KW, Greener LR, Matthews LT, Harrison A, Bangsberg DR, Safren SA, Smit JA, Psaros C. "I did not plan … that is what hurts": Pregnancy intentions and contraceptive use among pregnant young women in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:149-157. [PMID: 34003077 PMCID: PMC9996636 DOI: 10.2989/16085906.2021.1914693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unintended pregnancy impacts many young women in South Africa, and rates of consistent contraceptive use among this population are suboptimal. Limited empirical work has investigated reasons for inconsistency between pregnancy intention and contraceptive use behaviour with data collected during pregnancy. We explored pregnancy intentions and discordance between intentions and contraceptive use prior to conception among young pregnant women in KwaZulu-Natal, South Africa. In-depth qualitative interviews were conducted with 35 women during pregnancy (mean age = 19.3; range = 18-21) in 2011 and 2012. Data were analysed using content analysis. All participants reported unintended pregnancies; almost half were not using contraception near conception. Reasons for not intending to become pregnant spanned personal, social, health, and economic domains. Participants living with HIV (n = 13) expressed specific concerns related to impacts of pregnancy on HIV disease management and fear of transmission of HIV to the infant. Discordance between pregnancy intentions and contraceptive use prior to conception was attributed to personal, social, health and structural domains. Findings indicate a need for interventions that address barriers to contraceptive use in order to minimise unintended pregnancy and support safe, desired pregnancies among young women.
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Affiliation(s)
- Jessica N Coleman
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Cecilia Milford
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Karmel W Choi
- School of Public Health, Harvard University, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Letitia Rambally Greener
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
- Wits Reproductive Health and HIV Institute, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lynn T Matthews
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, USA
| | - Abigail Harrison
- Department of Behavioral Sciences, School of Public Health, Brown University, Providence, USA
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University – Portland State University, Portland, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, USA
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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15
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Roberts KJ, Smith C, Cluver L, Toska E, Sherr L. Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap. AIDS Behav 2021; 25:2094-2107. [PMID: 33452658 PMCID: PMC7810185 DOI: 10.1007/s10461-020-03138-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/28/2022]
Abstract
Adolescent (10-19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defined search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identified 2287 unique records. Of these, thirty-eight full-text quantitative records and seven full-text qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identified for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identified reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specific interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identified within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifies a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities.
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Affiliation(s)
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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16
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Hill LM, Saidi F, Freeborn K, Amico KR, Rosenberg NE, Maman S, Phanga T, Tsidya M, Chirwa S, Zimba C, Mutale W, Chi BH. Tonse Pamodzi: Developing a combination strategy to support adherence to antiretroviral therapy and HIV pre-exposure prophylaxis during pregnancy and breastfeeding. PLoS One 2021; 16:e0253280. [PMID: 34170913 PMCID: PMC8232532 DOI: 10.1371/journal.pone.0253280] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
To eliminate mother-to-child transmission of HIV (EMTCT), scalable strategies to enhance antiretroviral adherence for both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are needed as part of integrated HIV and maternal-child health services. We developed Tonse Pamodzi ("all of us together"), an adaptable intervention integrating biomedical and behavioral components to support HIV treatment and prevention. We describe our intervention development process, which comprised formative qualitative research, a review of the literature, and technical input from stakeholders representing the community, health systems, and policymakers. The resulting intervention, described herein, integrates patient-centered counseling and engagement of a patient-selected adherence supporter for pregnant and breastfeeding women initiating ART or PrEP. Patients receiving the intervention engage in Integrated Next Step Counseling (iNSC) sessions delivered by trained counselors to build and maintain adherence skills. Each patient also has the option of selecting an adherence supporter (partner, family member, or friend) who may participate in iNSC sessions and provide adherence support outside of these sessions. This flexible intervention is adaptable not only to ART or PrEP use, but also to the needs and preferences of each woman and the clinical context. If shown to be acceptable and feasible, the Tonse Pamodzi intervention may be an important tool in continuing efforts for EMTCT.
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Affiliation(s)
- Lauren M. Hill
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- * E-mail:
| | | | - Kellie Freeborn
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States of America
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Nora E. Rosenberg
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | | | | | | | | | - Wilbroad Mutale
- Department of Health Policy, University of Zambia School of Public Health, Lusaka, Zambia
| | - Benjamin H. Chi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States of America
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17
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van der Straten A, Ryan JH, Reddy K, Etima J, Taulo F, Mutero P, Taylor J, Piper J, Musara P. Influences on willingness to use vaginal or oral HIV PrEP during pregnancy and breastfeeding in Africa: the multisite MAMMA study. J Int AIDS Soc 2021; 23:e25536. [PMID: 32524700 PMCID: PMC7287313 DOI: 10.1002/jia2.25536] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/25/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Women in sub‐Saharan Africa spend a substantial portion of their reproductive lives pregnant and/or breastfeeding (P/BF), yet they have limited options to prevent HIV during these maternal stages. In preparation for phase 3b prevention trials in P/BF women, we explored attitudes about using a vaginal ring or oral pills for pre‐exposure prophylaxis (PrEP), perceptions of HIV risk during P/BF and key influences on future PrEP use. Methods In 2018, we conducted 16 single‐sex focus group discussions (FGDs) with community‐ and clinic‐recruited HIV‐uninfected women, currently or recently P/BF, aged 18 to 40, and men with (currently or recently) P/BF partners, aged 18+. Participants completed a behavioural questionnaire, viewed an educational video and handled prototype placebo products. FGDs were conducted in local languages and transcribed, coded and analysed, using a socio‐ecological framework, for key influences on willingness to use products, HIV risk perceptions and opinions on product attributes. Results Of the 128 participants (65 women, 63 men) 75% lived with their partner and 84% had a child. Women reported the most important influencers when P/BF were partners, and all stated that health decisions when P/BF are typically made jointly (e.g. medication use; ante/postnatal and baby care). There was consensus that P/BF women are at high risk for HIV, primarily because of their partner’s infidelities, and new prevention options were welcomed. Participants valued multiple options and stated that woman’s personal preference would be key to product choice. Anticipated concerns about products included risk of miscarriage, impact on infant development, complications during delivery and adequate production or taste of breastmilk. Specific perceived disadvantages emerged for the ring (e.g. vaginal discomfort, difficulty inserting/removing) and for pills (e.g. nausea/vomiting) that may be exacerbated during pregnancy. Health care providers’ (HCPs) knowledge and approval of product use during P/BF was needed to mitigate anticipated fears. Conclusions Participants perceived pregnancy and breastfeeding as high HIV risk periods and valued new prevention options. HIV protection of the mother‐child dyad, safety of the baby, and ultimately, health of the family were paramount. Endorsement by HCPs and support from partners were key to future product acceptance. Participants recommended involving partners and HCPs in sensitization efforts for future trials.
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Affiliation(s)
- Ariane van der Straten
- Women's Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA.,Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA, USA
| | - Julia H Ryan
- Women's Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Juliane Etima
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Frank Taulo
- Johns Hopkins Project-College of Medicine, University of Malawi, Blantyre, Malawi
| | - Prisca Mutero
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | - Petina Musara
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
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18
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Getaye A, Cherie N, Bazie GW, Gebremeskel Aragie T. Proportion of Depression and Its Associated Factors Among Youth HIV/AIDS Clients Attending ART Clinic in Dessie Town Government Health Facilities, Northeast Ethiopia. J Multidiscip Healthc 2021; 14:197-205. [PMID: 33551642 PMCID: PMC7856350 DOI: 10.2147/jmdh.s296849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression is the most prevalent among people living with HIV/AIDS than people without HIV/AIDS. Depression is associated with an increase in morbidity and mortality in people living with HIV/AIDS and adversely affects the adherence to antiretroviral therapy, quality of life, and health-related parameters. OBJECTIVE The aim of this study was to assess the proportion of depression and its associated factors among youth HIV/AIDS patients attending ART clinics in Dessie town Government health facilities, Northeast Ethiopia. METHODS Institutional-based cross-sectional study design was employed on 431 youth HIV/AIDS patients attending ART clinics at Dessie town Public health facilities. Data were collected by face-to-face interview using a structured questionnaire. EPI-Data software version 3.1 was used to enter the data and analysis was done using SPSS version 23. Binary logistic regression was used to identify factors associated with depression. Statistical significance was declared at a p-value of less than 0.05 in the final model. RESULTS The proportion of depression among youth HIV/AIDS patients was 26.2%. The age range between 20 and 24 years (AOR = 2.019, 95% CI: 1.143-3.566), poor medication adherence (AOR = 9.007, 95% CI: 3.061-26.500), stigma (AOR = 4.14, 95% CI: 2.08-8.26), and low social support (AOR = 1.854, 95% CI: 1.034-3.324) were associated with depression. CONCLUSION The proportion of depression among youth HIV patients in the current study was found to be lower compared to previous studies. Age, HIV-related stigma, social support, lost job, and poor medication adherence were found to be independent predictors of depression. Therefore, scaling up the pediatric psychosocial support program to youth psychosocial support for all ART site health facilities, strengthening health education about the medication adherence and complication of HIV/AIDS are needed.
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Affiliation(s)
- Amare Getaye
- Wollo University, College of Medicine and Health Sciences, School of Public Health, Dessie, Ethiopia
| | - Niguss Cherie
- Wollo University, College of Medicine and Health Sciences, School of Public Health, Dessie, Ethiopia
| | - Getaw Walle Bazie
- Wollo University, College of Medicine and Health Sciences, School of Public Health, Dessie, Ethiopia
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19
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Millar HC, Keter AK, Musick BS, Apondi E, Wachira J, MacDonald KR, Spitzer RF, Braitstein P. Decreasing incidence of pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya between 2005 and 2017: a retrospective cohort study. Reprod Health 2020; 17:191. [PMID: 33267899 PMCID: PMC7709285 DOI: 10.1186/s12978-020-01031-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya. METHODS The Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents aged 10-19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic medical records and summarized using descriptive statistics. Follow up time was defined as time of inclusion in the cohort until the date of first pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent pregnancy rates and associated risk factors were determined. RESULTS There were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only 17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104) were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once during follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and 2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older, to be married or living with a partner and to have at least one child already and less likely to be using family planning. CONCLUSIONS A considerable number of these HIV-positive adolescents presented at enrolment into HIV care as pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.
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Affiliation(s)
- Heather C Millar
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya. .,Section of Gynaecology, Division of Endocrinology, SickKids Hospital, 555 University Avenue, 7th Floor, Black Wing, Toronto, ON, M5G 1X8, Canada. .,Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G 1E2, Canada.
| | - Alfred K Keter
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya
| | - Beverly S Musick
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Moi Teaching and Referral Hospital, Nandi Road, Uasin Gishu County, PO Box 3-30100, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Behavioral Sciences, Moi University, College of Health Sciences, PO Box 4606, Eldoret, 30100, Kenya
| | - Katherine R MacDonald
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Riley Hospital 5900, Indianapolis, IN, 46202, USA
| | - Rachel F Spitzer
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Section of Gynaecology, Division of Endocrinology, SickKids Hospital, 555 University Avenue, 7th Floor, Black Wing, Toronto, ON, M5G 1X8, Canada.,Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G 1E2, Canada
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Moi University, College of Health Sciences, School of Medicine, PO Box 4606, Eldoret, 30100, Kenya
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Tokwe L, Naidoo JR. Lived experiences of human immunodeficiency virus and hypertension in the Eastern Cape, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 33181880 PMCID: PMC7669966 DOI: 10.4102/phcfm.v12i1.2472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Globally, the healthcare system is burdened with the rise in communicable diseases compounded by the comorbidity of non-communicable diseases. South Africa in particular experiences a quadruple burden of diseases, and human immunodeficiency virus (HIV) and hypertension are amongst the burden of diseases reported. Aim This article aims to explore and describe the lived experiences of people living with HIV (PLWH) and hypertension in the Eastern Cape, South Africa. Setting The study was conducted in the Sakhisizwe sub-district within the Chris Hani health district of the Eastern Cape. Methods A qualitative study design using Husserl’s descriptive phenomenology underpinned this study. Purposive sampling method was used to select participants. Information was gathered using semi-structured interviews from nine participants who met the inclusion criteria. The interviews were recorded on an audiotape and conducted in isiXhosa, and these were verified through back and forward translation to English. The transcribed interviews were coded manually, and underpinned by Giorgi’s phenomenological data analysis steps. Results This study yielded four themes that described the journey towards a new normal experienced by participants. These themes were (1) overcoming illness-related stigma, (2) sources of support, (3) self-love: taking ownership of the diseases and (4) creating transforming behaviours and self-care strategies. Conclusion This study demonstrated that the central theme that emerged from the lived experiences of participants with HIV and hypertension was a process of finding a new normal for their lives. This process had several enabling and inhibiting conditions that enabled participants to develop self-acceptance and find strategies to transform behaviours to better live with two chronic illnesses.
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Affiliation(s)
- Lwandile Tokwe
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth.
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21
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Toska E, Laurenzi CA, Roberts KJ, Cluver L, Sherr L. Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa. Glob Public Health 2020; 15:1655-1673. [PMID: 32507031 DOI: 10.1080/17441692.2020.1775867] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.,Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Christina A Laurenzi
- Institute for Life Course Health Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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22
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Erasmus MO, Knight L, Dutton J. Barriers to accessing maternal health care amongst pregnant adolescents in South Africa: a qualitative study. Int J Public Health 2020; 65:469-476. [PMID: 32388574 PMCID: PMC7275000 DOI: 10.1007/s00038-020-01374-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives This study explores the barriers to accessing antenatal care (ANC) services amongst pregnant adolescents within a particular community of South Africa. Methods An exploratory qualitative design was applied to examine the views of pregnant adolescents. In-depth interviews were conducted with pregnant adolescents at the Mitchells Plain Midwifery Obstetric Unit, as well as nursing staff working at the facility. Thematic analysis was then used and analysis was framed using the social–ecological model for health-seeking behaviour. Results This study found that barriers to adolescents seeking ANC often centered on a discourse of adolescent pregnancy being deviant, irresponsible, and shameful. Pregnant adolescents often absorbed these beliefs and were fearful of other’s reaction within their family, the community, at school, and within the ANC facilities. Conclusions Stigma regarding adolescent pregnancy participates in the perpetuation of a culture of non-disclosure and shame, which stands in the way of young pregnant people seeking the care they require. Such beliefs and attitudes need to be challenged at a community and national level. Electronic supplementary material The online version of this article (10.1007/s00038-020-01374-7) contains supplementary material, which is available to authorised users.
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Affiliation(s)
| | - Lucia Knight
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Jessica Dutton
- School of Public Health, University of Western Cape, Cape Town, South Africa
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Ng’eno B, Rogers B, Mbori-Ngacha D, Essajee S, Hrapcak S, Modi S. Understanding the uptake of prevention of mother-to-child transmission services among adolescent girls in Sub-Saharan Africa: a review of literature. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2019. [DOI: 10.1080/02673843.2019.1699124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Bernadette Ng’eno
- Division of Global HIV and Tuberculosis, U.S Centers for Disease Control and Prevention (CDC) , Atlanta, GA, USA
| | - Braeden Rogers
- Health Section, UNICEF Eastern and Southern Africa Regional Office , Nairobi, Kenya
| | | | | | - Susan Hrapcak
- Division of Global HIV and Tuberculosis, U.S Centers for Disease Control and Prevention (CDC) , Atlanta, GA, USA
| | - Surbhi Modi
- Division of Global HIV and Tuberculosis, U.S Centers for Disease Control and Prevention (CDC) , Atlanta, GA, USA
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24
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Luseno WK, Iritani BJ, Maman S, Mbai I, Ongili B, Otieno FA, Hallfors DD. "If the mother does not know, there is no way she can tell the adolescent to go for drugs": Challenges in promoting health and preventing transmission among pregnant and parenting Kenyan adolescents living with HIV. CHILDREN AND YOUTH SERVICES REVIEW 2019; 103:100-106. [PMID: 31308586 PMCID: PMC6628199 DOI: 10.1016/j.childyouth.2019.05.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Adolescents living with HIV (ALHIV) who are pregnant, or parenting, are an important but understudied group. This study explores the challenges in promoting the health of these adolescents and preventing onward transmission. We used existing semi-structured interview data from a 2014 study conducted among Kenyan ALHIV (ages 15-19), their family members, and local health staff to examine adolescent HIV-testing, disclosure, and treatment engagement, focusing on participants who were pregnant, had given birth, or had fathered a child. A total of 28 participant interviews were analyzed, including those conducted with nine ALHIV, four family members, and 15 HIV providers. Four adolescent participants were not in care at the time of their interview. Our analysis also included a transcript from a stakeholder meeting involving HIV providers and associated administrators, held to disseminate and garner feedback on, preliminary findings from the original study. Based on our analysis, adolescents frequently reported being alone during testing, experiencing fear and denial on receiving their results, and delaying disclosure to family and linkage to treatment. They also mentioned a lack of contraceptive counseling, with some reporting multiple pregnancies. Providers voiced misgivings and uncertainty about disclosing HIV diagnoses to minor adolescents without a family member present and reported severe shortages of personnel and resources to adequately serve ALHIV in rural clinics. These findings highlight gaps in services that limit adolescent engagement in HIV treatment prior to sexual debut and conceiving a child, and in PMTCT during and after pregnancy. Greater research attention is needed to address ALHIV reproductive health needs, improve linkage to HIV treatment, and prevent onward sexual transmission. Empirical ethics studies of current adolescent disclosure policies are also warranted to examine cultural and developmental appropriateness, and effectiveness in fostering support and engagement in HIV services.
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Affiliation(s)
- Winnie K. Luseno
- Pacific Institute for Research and Evaluation (PIRE), 101
Conner Dr., Ste 200, Chapel Hill, NC 27514, United States of America
| | - Bonita J. Iritani
- Pacific Institute for Research and Evaluation (PIRE), 101
Conner Dr., Ste 200, Chapel Hill, NC 27514, United States of America
| | - Suzanne Maman
- Department of Health Behavior and Health Education,
University of North Carolina, Chapel Hill 27599, United States of America
| | - Isabella Mbai
- College of Health Sciences, School of Nursing, Moi
University, P.O. Box 4606, Eldoret, Kenya
| | - Barrack Ongili
- Centre for Global Health Research, Kenya Medical Research
Institute (KEMRI), Busia Road, P.O. Box 1578, 40100 Kisumu, Kenya
| | - Florence Anyango Otieno
- Centre for Global Health Research, Kenya Medical Research
Institute (KEMRI), Busia Road, P.O. Box 1578, 40100 Kisumu, Kenya
| | - Denise Dion Hallfors
- Pacific Institute for Research and Evaluation (PIRE), 101
Conner Dr., Ste 200, Chapel Hill, NC 27514, United States of America
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Prevalence of Depressive Symptoms and Associated Factors among HIV-Positive Youth Attending ART Follow-Up in Addis Ababa, Ethiopia. AIDS Res Treat 2019; 2019:4610458. [PMID: 30719348 PMCID: PMC6334359 DOI: 10.1155/2019/4610458] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/15/2018] [Accepted: 11/22/2018] [Indexed: 12/31/2022] Open
Abstract
Depression is most frequently and highly occurring common mental disorder in HIV/AIDS patients especially youth living with HIV/AIDS. This study aimed to assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals in Addis Ababa, Ethiopia. Objective. To assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals Addis Ababa, Ethiopia, 2016. Method. In a cross sectional study, 507 HIV-positive young people from public health hospitals were recruited by systematic random sampling technique. Beck Depression Inventory-II was used to assess depressive symptoms. Morisky medication adherence rating scale, social support rating scale, and HIV stigma scale were the instruments used to assess the associated factors. Results. Prevalence of depressive symptoms among HIV-positive youth was 35.5% (95% CI:31.3, 39.6). In multivariate analysis, age range between 20 and 24 years with (AOR=2.22, 95% CI: 1.33,3.62), history of opportunistic infection (AOR=1.94, 95% CI:1.15,3.27), poor medication adherence (AOR=1.73, 95%CI:1.13,2.64, low social support (AOR=2.74, 95%CI:1.13,2.64), moderate social support (AOR=1.75 95% CI: 1.03,2.98), and stigma (AOR=2.06, 95% CI: 1.35,3.14) were associated with depressive symptoms. The results suggest that prevalence of depressive symptoms among HIV-positive youth was high. Prevention of opportunistic infection, stigma, and counseling for good medication adherence are necessary among HIV-positive youth.
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Groves AK, Hallfors DD, Iritani BJ, Rennie S, Odongo FS, Kwaro D, Amek N, Luseno WK. "I think the parent should be there because no one was born alone": Kenyan adolescents' perspectives on parental involvement in HIV research. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:227-239. [PMID: 30319046 DOI: 10.2989/16085906.2018.1504805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite a pressing need for adolescent HIV research in sub-Saharan Africa, ethical guidance for conducting research among minor adolescents is lacking. One ethical issue is the degree to which parents should be involved in the research process. The existing discourse is predominantly speculative and focuses on negative consequences of parental involvement. We use empirical data to describe the perspectives of Kenyan adolescents on parental involvement in consent and disclosure of HIV test results within a research study context. We conducted two rounds of focus group discussions with 40 adolescents in western Kenya to ask about minor adolescent participation in HIV research. We analysed data using codes and matrices. Kenyan adolescents were largely in favour of parental involvement during the research process. Half felt adolescent minors should solicit parental consent to participate, and nearly all said parents should learn the HIV test results of adolescent minors in order to provide necessary support. From their perspective, involvement of parents in research extends beyond obtaining their consent to providing essential support for youth, regardless of HIV status, both during and beyond the research study. Ethical guidelines that prioritise adolescent autonomy in research must consider reasons to involve parents considered important by adolescents themselves, particularly in low-resource settings.
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Affiliation(s)
- Allison K Groves
- a Department of Community Health and Prevention , Drexel University , Philadelphia , USA
| | | | - Bonita J Iritani
- b Pacific Institute for Research and Evaluation , Chapel Hill , USA
| | - Stuart Rennie
- c Department of Social Medicine , University of North Carolina , Chapel Hill , USA
| | - Fredrick S Odongo
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Daniel Kwaro
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Nyaguara Amek
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Winnie K Luseno
- b Pacific Institute for Research and Evaluation , Chapel Hill , USA
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Mlotshwa L, Manderson L, Merten S. Personal support and expressions of care for pregnant women in Soweto, South Africa. Glob Health Action 2018; 10:1363454. [PMID: 28874098 PMCID: PMC5645695 DOI: 10.1080/16549716.2017.1363454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Pregnancy is life changing, making great demands on women to adapt physically, psychologically, and socially. Social relationships and the support that flow from these provide a critical role in managing health problems in pregnancy. Isolation and lack of care, in contrast, may lead women to experience increased distress during this time. Objective: This study aimed to explore South African women's perception and experience of care and support in pregnancy. Methods: A life history approach was employed to explore women’s experiences of pregnancy and sexual behaviour, with each participant encouraged to narrate important life events from her own perspective. We drew on narrative interviews with 15 pregnant women, conducted between July and October 2015, in which we explored questions regarding pregnancy planning and the provision and receipt of care. A thematic approach was employed to code and analyse the data. Results: Themes that emerged from the interviews showed that participants gained a sense of stability in their lives when they had support in their pregnancy, especially when dealing with challenging situations. This support came variously from family, friends, and social networks. Overall, those participants who mentioned the most support, and its diversity across different groups, reported a better experience of pregnancy. Conclusions: Women emphasised the importance of social and emotional support in pregnancy. Understanding women’s experiences can assist in making pregnancy less overwhelming, and can add to a woman’s ability to deal with different challenges before and after the arrival of the new baby.
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Affiliation(s)
- Langelihle Mlotshwa
- a Department of Epidemiology and Public Health , Swiss Tropical Public Health Institute , Basel , Switzerland.,b Department of Epidemiology and Public Health , University of Basel , Basel , Switzerland.,c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Lenore Manderson
- d School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Sonja Merten
- a Department of Epidemiology and Public Health , Swiss Tropical Public Health Institute , Basel , Switzerland.,b Department of Epidemiology and Public Health , University of Basel , Basel , Switzerland
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28
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Groves AK, Maman S, Stankard PH, Gebrekristos LT, Amon JJ, Moodley D. Addressing the unique needs of adolescent mothers in the fight against HIV. J Int AIDS Soc 2018; 21:e25155. [PMID: 29956491 PMCID: PMC6024120 DOI: 10.1002/jia2.25155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/11/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Allison K Groves
- Department of Community Health and PreventionDrexel UniversityPhiladelphiaPAUSA
| | - Suzanne Maman
- Department of Health BehaviorUniversity of North Carolina at Chapel HillsChapel HillNCUSA
| | | | | | - Joseph J Amon
- Woodrow Wilson School of Public and International AffairsPrinceton UniversityPrincetonNJUSA
| | - Dhayendre Moodley
- Department of Obstetrics and GynaecologyUniversity of KwaZulu‐NatalNelson Mandela School of MedicineDurbanSouth Africa
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29
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Jama NA, Wilford A, Haskins L, Coutsoudis A, Spies L, Horwood C. Autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa. BMC Pregnancy Childbirth 2018; 18:52. [PMID: 29454323 PMCID: PMC5816555 DOI: 10.1186/s12884-018-1675-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 01/29/2018] [Indexed: 11/18/2022] Open
Abstract
Background The nutritional status of infants born to teenage mothers can be sub-optimal compared to those born to older mothers. One contributing factor is inappropriate feeding practices adopted by teenage mothers. Little is known about how infant feeding decisions are made among teenage mothers, particularly in under resourced settings. In this study we prospectively explored autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa. Methods This study adopted a qualitative longitudinal design. Thirty pregnant participants were recruited to the study cohort, from the catchment area of two hospitals (one urban and one rural). Participants were purposively selected to include teenagers, HIV positive, and working pregnant women. We report findings from ten teenage mothers, aged between 15 and 19 years, who participated in the larger cohort (n = 5 rural; n = 5 urban). Monthly in-depth interviews were conducted with participating mothers for 6 months starting 2 weeks after delivery. All interviews were conducted in the local language, transcribed verbatim and translated into English. Data was coded using NVivo v10 and framework analysis was used. Results Findings from this study showed that teenage mothers had knowledge about recommended feeding practices. However, our findings suggest that these mothers were not involved in infant feeding decisions once they were at home, because infant feeding decision-making was a role largely assumed by older mothers in the family. Further, the age of the mother and financial dependency diminished her autonomy and ability to influence feeding practices or challenge incorrect advice given at home. Most feeding advice shared by family members was inappropriate, leading to poor infant feeding practices among teenage mothers. Returning to school and fear of breastfeeding in public were also barriers to exclusive breastfeeding. Conclusion Teenage mothers had a limited role in the infant feeding decision-making process. Health workers have an important role to play in ensuring that knowledge about infant feeding is shared with the mother’s family where infant feeding choices are made. This will improve support for teenage mothers, and may also positively impact on the nutritional status of children.
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Affiliation(s)
| | - Aurene Wilford
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- Department of Pediatrics & Child Health, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lenore Spies
- Department of Health, Pietermaritzburg, South Africa
| | - Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
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Abstract
Introduction: HIV-infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV-infected pregnant adolescents in low-income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group. Discussion: Emerging data from programmes in sub-Saharan Africa highlight that HIV-infected pregnant adolescents have poorer prevention of mother-to-child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV-infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother-to-child HIV transmission among infants of HIV-infected pregnant adolescents. Conclusions: While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent-friendly services into PMTCT settings or targeting HIV-infected pregnant adolescents with enhanced retention and follow-up activities.
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Patterns of HIV Care Clinic Attendance and Adherence to Antiretroviral Therapy Among Pregnant and Breastfeeding Women Living With HIV in the Context of Option B+ in Zimbabwe. J Acquir Immune Defic Syndr 2017; 75 Suppl 2:S198-S206. [PMID: 28498190 DOI: 10.1097/qai.0000000000001347] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Consistent use of antiretroviral therapy (ART) during pregnancy and breastfeeding reduces the likelihood of mother-to-child HIV transmission. All pregnant and breastfeeding women living with HIV in Zimbabwe are offered ART with same-day initiation regardless of CD4 count (Option B+). We investigated patterns of clinic attendance and adherence to ART among HIV-infected pregnant women in Zimbabwe. METHODS The Evidence for Elimination cluster-randomized trial evaluating point-of-care CD4 testing included 1150 HIV-infected ART-naive women attending antenatal care between January 2014 and June 2015. Thirty-two primary care facilities were randomized between 2 arms. In this secondary analysis of Evidence for Elimination data collected from routine clinic records, we classified women by number of pills dispensed, and estimated adherence from the ratio of pills to days since ART initiation (Medication Possession Ratio, adherent if ≥95%) or the period when they stopped receiving medication. RESULTS Two-thirds (67.7%) were still receiving medication 1 year after initiation; less than half of the cohort (39.1%) were adherent. Younger women, newly diagnosed with HIV, and/or first presenting to antenatal care in their third trimester were more likely to drop from care or be nonadherent 360 days after ART initiation. CONCLUSION Adherence to ART is suboptimal particularly among young, newly diagnosed, and/or late presenting patients. Interventions that target these groups, as well as provide additional support to all women who are newly diagnosed, may improve Option B+ ART care. More information is needed about the barriers to ART care among late presenters and teenagers.
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Chetty T, Vandormael A, Thorne C, Coutsoudis A. Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa. BMC Pregnancy Childbirth 2017; 17:248. [PMID: 28747163 PMCID: PMC5530557 DOI: 10.1186/s12884-017-1421-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/16/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquisition where antiretroviral therapy was widely available in a high HIV prevalence setting. METHODS This is a retrospective cohort study nested within a population-based surveillance to determine HIV incidence in HIV-uninfected women from 15 to 49 years from 2010 through 2015 in rural KwaZulu-Natal. HIV incidence per 100 person-years according to pregnancy status (not pregnant, pregnant, to eight weeks postpartum) were measured in 5260 HIV-uninfected women. Hazard ratios (HR) were estimated by Cox proportional hazards regression with pregnancy included as a time varying variable. RESULTS Overall, pregnancy HIV incidence was 4.5 per 100 person-years (95% CI 3.4-5.8), higher than non-pregnancy (4.0; 95% CI 3.7-4.3) and postpartum incidences (4.2 per 100 person-years; 95% CI 2.3-7.6). However, adjusting for age, and demographic factors, pregnant women had a lower risk of acquiring HIV (HR 0.4; 95% CI 0.2-0.9, P = 0.032) than non-pregnant women; there were no differences between postpartum and non-pregnant women (HR 1.2; 95% CI 0.4-3.2; P = 0.744). In models adjusting for the interaction of age and gravidity, pregnant women under 25 years with two or more pregnancies had a 2.3 times greater risk of acquiring HIV than their older counterparts (95% CI 1.3-4.3; P = 0.008). CONCLUSIONS Pregnancy had a protective effect on HIV acquisition. Elevated HIV incidence in younger women appeared to be driven by those with higher gravidity. The sexual and biological factors in younger women should be explored further in order to design appropriate HIV prevention interventions.
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Affiliation(s)
- Terusha Chetty
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| | - Alain Vandormael
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
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Ronen K, McGrath CJ, Langat AC, Kinuthia J, Omolo D, Singa B, Katana AK, Ng’Ang’A LW, John-Stewart G. Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya. J Acquir Immune Defic Syndr 2017; 74:30-37. [PMID: 27599005 PMCID: PMC5895459 DOI: 10.1097/qai.0000000000001176] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS We conducted a nationally representative cross-sectional survey of mother-infant pairs attending 120 maternal child health clinics selected by probability proportionate to size sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. Antenatal care (ANC) attendance, HIV testing, and antiretroviral (ARV) use were compared between adolescent (age ≤19 years) and adult mothers using χ tests and logistic regression. RESULTS Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (P < 0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, P = 0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity, and HIV status [adjusted odds ratio (95% confidence interval) = 0.54 (0.37 to 0.97), P = 0.001]. Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on antiretroviral therapy before pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, P = 0.01) or to have infants on ARVs (85.7% vs. 97.7%, P = 0.005). CONCLUSIONS Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.
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Affiliation(s)
- Keshet Ronen
- Departments of Global Health and Epidemiology, University of Washington, Seattle, WA
| | - Christine J. McGrath
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Agnes C. Langat
- Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Danvers Omolo
- Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Benson Singa
- Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Lucy W. Ng’Ang’A
- Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, Epidemiology, Medicine and Pediatrics, University of Washington, Seattle, WA
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Ojwang' VO, Penner J, Blat C, Agot K, Bukusi EA, Cohen CR. Loss to follow-up among youth accessing outpatient HIV care and treatment services in Kisumu, Kenya. AIDS Care 2015; 28:500-7. [PMID: 26565428 DOI: 10.1080/09540121.2015.1110234] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Youth are particularly vulnerable to acquiring HIV, yet reaching them with HIV prevention interventions and engaging and retaining those infected in care and treatment remains a challenge. We sought to determine the incidence rate of loss to follow-up (LTFU) and explore socio-demographic and clinical characteristics associated with LTFU among HIV-positive youth aged 15-21 years accessing outpatient care and treatment clinics in Kisumu, Kenya. Between July 2007 and September 2010, youth were enrolled into two different HIV care and treatment clinics, one youth specific and the other family oriented. An individual was defined as LTFU when absent from the HIV treatment clinic for ≥ 4 months regardless of their antiretroviral treatment status. The incidence rate of LTFU was calculated and Cox regression analysis used to identify factors associated with LTFU. A total of 924 youth (79% female) were enrolled, with a median age of 20 years (IQR 18-21). Over half, (529 (57%)), were documented as LTFU, of whom 139 (26%) were LTFU immediately after enrolment. The overall incidence rate of LTFU was 52.9 per 100 person-years (p-y). Factors associated with LTFU were pregnancy during the study period (crude HR 0.68, 95% CI 0.53-0.89); CD4 cell count >350 (adjusted hazard ratios (AHR) 0.59, 95% CI 0.39-0.90); not being on antiretroviral therapy (AHR 4.0, 95% CI 2.70-5.88); and non-disclosure of HIV infection status (AHR 1.43, 95% CI 1.10-1.89). The clinic of enrolment, age, marital status, employment status, WHO clinical disease stage and education level were not associated with LTFU. Interventions to identify and enrol youth into care earlier, support disclosure, and initiate ART earlier may improve retention of youth and need further investigation. Further research is also needed to explore the reasons for LTFU from care among HIV-infected youth and the true outcomes of these patients.
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Affiliation(s)
- V O Ojwang'
- a Family AIDS Care & Education Services (FACES) , Centre for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI) , Nairobi , Kenya
| | - J Penner
- a Family AIDS Care & Education Services (FACES) , Centre for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI) , Nairobi , Kenya.,b Department of Family Practice , University of British Columbia , Vancouver , Canada
| | - C Blat
- a Family AIDS Care & Education Services (FACES) , Centre for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI) , Nairobi , Kenya.,c Department of Obstetrics, Gynaecology & Reproductive Sciences , University of California , San Francisco , CA , USA
| | - K Agot
- d Impact Research and Development Organization , Kisumu , Kenya
| | - E A Bukusi
- a Family AIDS Care & Education Services (FACES) , Centre for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI) , Nairobi , Kenya
| | - C R Cohen
- a Family AIDS Care & Education Services (FACES) , Centre for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI) , Nairobi , Kenya.,c Department of Obstetrics, Gynaecology & Reproductive Sciences , University of California , San Francisco , CA , USA
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Mbalinda SN, Kiwanuka N, Kaye DK, Eriksson LE. Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda. Health Qual Life Outcomes 2015; 13:170. [PMID: 26490047 PMCID: PMC4618375 DOI: 10.1186/s12955-015-0366-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/14/2015] [Indexed: 01/14/2023] Open
Abstract
Background With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. Methods In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10–19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. Results The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24–3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22–6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86–15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05–3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40–0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18–0.62) were associated with poorer mental health. Conclusion Among perinatally HIV-infected adolescents in Uganda, being on ART was associated with better physical and mental health while lack of communication with guardians on sexuality or dissatisfaction with SRH services was associated with poor mental health. Adolescents with pregnancy intentions were more likely to have a better mental health.
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Affiliation(s)
- Scovia Nalugo Mbalinda
- Department of Nursing, School of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda.
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. .,School of Health Sciences, City University London, London, UK.
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