Characteristics of adolescents living with HIV receiving care and treatment services in antiretroviral therapy clinics in Cambodia: descriptive findings from a cross-sectional study

Depression and its association with psychological factors among adolescents living with HIV in Southwestern Nigeria

OBJECTIVE

The aim was to determine the prevalence of depressive disorder and associated psychological factors among adolescents living with HIV/AIDS.

METHODS

One hundred and five adolescents with HIV were assessed for self-esteem, internalized HIV stigma and diagnosed of depressive disorder. Chi square and t tests were used to test associations and hierarchical logistic regression used to identify independent risk factors for depression.

RESULTS

The mean age of participants was 16.5 (± 1.97) years and 55.2% were males. Mean stigma scores were significantly higher in those with depressive disorder (16.53 ± 3.85) when compared with those without (13.42 ± 3.464) and this difference was statistically significant (t = 3.17, p = 0.01). The mean self-esteem scores were significantly lower in participants with depressive disorder (17.53 ± 4.69) compared to those without depressive disorder (19.71 ± 3.86), though not significant (t = 1.96, p = 0.053). Depressive disorder was further significantly associated with female sex, being in romantic relationship, decline in work output due to HIV and HIV stigma. Independent risk factors were sex and HIV stigma.

CONCLUSION

Depressive disorder is common among adolescents living with HIV infection in Nigeria. The association between HIV stigma and depression, thus suggests the need for prevention strategies targeting the impacts of HIV infection among adolescents.

Clinical outcomes among adolescents living with HIV in Kenya following initiation on antiretroviral treatment

In Kenya, HIV/AIDS remains a leading cause of morbidity and mortality among adolescents living with HIV (ALHIV). Our study evaluated associations between demographic and healthcare factors and HIV treatment outcomes among ALHIV in care in Kenya. This retrospective cohort study evaluated the clinical outcomes of newly diagnosed ALHIV enrolled in HIV care during January 2017-June 2018 at 32 healthcare facilities in Homabay and Kakamega Counties. Demographic and clinical data were abstracted from patient clinical records and registers during the follow up study period January 2017-through May 2019. ALHIV were stratified by age (10-14 versus 15-19 years). Categorical variables were summarized using descriptive statistics; continuous variables were analyzed using mean values. The latest available treatment and virological outcomes for ALHIV were assessed. 330 ALHIV were included in the study (mean age 15.9 years; 81.8% female, 63.0% receiving HIV care at lower-level healthcare facilities). Most (93.2%) were initiated on ART within 14 days of diagnosis; 91.4% initiated EFV-based regimens. Of those on ART, only 44.6% were active on care at the end of the study period. Of those eligible for viral load testing, 83.9% were tested with 84.4% viral suppression rate. Retention in care was higher at higher-level facilities (67.5%) compared to lower-level facilities (28.6%). Factors associated with higher retention in care were school attendance (aRR = 1.453), receipt of disclosure support (aRR = 13.315), and receiving care at a high-level health facility (aRR = 0.751). Factors associated with viral suppression included older age (15-19 years) (aRR = 1.249) and pre-ART clinical WHO stage I/II (RR = .668). Viral suppression was higher among older ALHIV. Studies are needed to evaluate effective interventions to improve outcomes among ALHIV in Kenya.

Transitioning from pediatric to adult care and the HIV care continuum in Ghana: a retrospective study

BACKGROUND

In Sub-Saharan Africa, there are now a significant number of adolescents living with HIV (ALHIV), due to increased access to effective antiretroviral therapy. However, these adolescents are at high risk of dying during the transition to adult care due to various reasons, including lack of preparation for the transition and poor transition arrangements. More knowledge about this issue will lead to a better planned healthcare transition process and preparation for transition from pediatric care to adult care. The aim of this study was to explore the healthcare transitional experiences of ALHIV as they moved from pediatric to adult care.

METHODS

A descriptive exploratory qualitative study was conducted. Purposive sampling method was used to recruit adolescents between 12 and 19 years old. Saturation was realized by the 10th participant. Data were analyzed using thematic content analysis.

RESULTS

Four main themes emerged from the interview data: the transition process, factors facilitating the transition experience, challenges and coping mechanisms of the ALHIV during transition, and suggestions for improvement based on perceptions on the current transitioning approach. A key finding of this study was the sudden preparation for transition, linked to the absence of a structured transition protocol. Even though age was the main reason for transferring the participants from the pediatric to adult clinic, participants' age did not influence whether they attended clinic appointment on their own or accompanied by a care provider; it was dependent on the availability of their parents or caregivers. Participants' parents and adult family caregivers were also integrated into the transition process to some extent. We also found that most of the participants had good patient-provider relationship with their health care providers in both pediatric and adult clinics.

CONCLUSION

Findings support the need to develop a structured healthcare transition policy and age-appropriate transition within the clinic environment. There is also a need for social and community support as ALHIV transition from pediatric to adult care.

Socioeconomic, clinical, and behavioral characteristics of adolescents living with HIV in Southwest Nigeria: implication for preparedness for transition to adult care

There is a need to generate data that demonstrate preparedness (or a lack of it) of adolescents to crossover to adult care to inform policy and create appropriate models in LMICs. This cross-sectional survey of 252 adolescents (15-19 years) receiving HIV-care assessed sociodemographic characteristics, clinical and ART status, and HIV-related behaviors. Also, the study appraised HIV status awareness, and disclosure, and access to healthcare. The mean age of the participants was 16.41 (SD = 1.41) years, and 128 (50.8%) of them were female. The mean adherence level (by VAS) reported was 73.05 ± 16.75. The most frequently reported reasons for missing medications were forgetting (39.6%), falling asleep (37.7%), being away from home (33.8%), and being too busy with other endeavors (32.6%). Most (93.7%) of the participants paid for health care services out-of-pocket. Many (38.1%) of them did not know how they acquired HIV infection. About half (44.8%) of them had boy/girlfriends, but only 25 (9.9%) reported ever having sex. Only 4% disclosed their HIV status to their boy/girlfriends. Critical gaps exist in adolescents' preparedness for transition to adult HIV-care, necessitating the need for specific transition preparedness programs within the HIV-care cascade to address the peculiar needs of adolescents at this stage.Trial registration: ClinicalTrials.gov identifier: NCT03394391.

Nutritional status and dietary diversity of school-age children living with HIV: a cross-sectional study in Phnom Penh, Cambodia

Background

HIV/AIDS continues to be a major public health concern for children. Each day, worldwide, approximately 440 children became newly infected with HIV, and 270 children died from AIDS-related causes in 2018. Poor nutrition has been associated with accelerated disease progression, and sufficient dietary diversity is considered a key to improve children’s nutritional status. Therefore, this study aims to 1) examine nutritional status of school-age children living with HIV in Phnom Penh, Cambodia, and 2) identify factors associated with their nutritional status, especially taking their dietary diversity into consideration.

Methods

This cross-sectional study was conducted in May 2018 within the catchment area of the National Pediatric Hospital, Cambodia. Data from 298 children and their caregivers were included in the analyses. Using semi-structured questionnaires, face-to-face interviews were conducted to collect data regarding sociodemographic characteristics, quality of life, and dietary diversity. To assess children’s nutritional status, body weight and height were measured. Viral load and duration of antiretroviral therapy (ART) were collected from clinical records. Multiple logistic regression analyses were performed to identify factors associated with stunting and wasting.

Results

Of 298 children, nearly half (46.6%) were stunted, and 13.1% were wasted. The mean number of food groups consumed by the children in the past 24 h was 4.6 out of 7 groups. Factors associated with children’s stunting were age (adjusted odds ratio [AOR] 2.166, 95% confidence interval [CI]: 1.151, 4.077), household wealth (AOR 0.543, 95%CI: 0.299, 0.986), duration of receiving ART (AOR 0.510, 95%CI: 0.267, 0.974), and having disease symptoms during the past 1 year (AOR 1.871, 95%CI: 1.005, 3.480). The only factor associated with wasting was being male (AOR 5.304, 95%CI: 2.210, 12.728).

Conclusions

Prevalence of stunting was more than double that of non-infected school-age children living in urban areas in Cambodia. This highlights the importance of conducting nutritional intervention programs, especially tailored for children living with HIV in the country. Although dietary diversity was not significantly associated with children’s nutritional status in this study, the findings will contribute to implementing future nutritional interventions more efficiently by indicating children who are most in need of such interventions in Cambodia.