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Kizito S, Nabunya P, Ssewamala FM. Enhancing Adherence to Antiretroviral Therapy Among Adolescents Living With HIV Through Group-Based Therapeutic Approaches in Uganda: Findings From a Pilot Cluster-Randomized Controlled Trial. J Pediatr Psychol 2023; 48:907-913. [PMID: 37935531 PMCID: PMC10653347 DOI: 10.1093/jpepsy/jsad081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE We examine the preliminary impact of group-cognitive behavioral therapy (G-CBT) versus a family-strengthening intervention delivered via multiple family group (MFG) in improving ART adherence among adolescents living with HIV (ALHIV) in Uganda. METHODS We analyzed data from a pilot cluster-randomized trial (2020-2022) conducted in 9 clinics in Uganda among 89 participants, who were eligible out of the 147 ALHIV screened. Participants were eligible if they were aged 10-14 years, HIV positive, taking ART, and living with a family. Adolescents were randomized, at the clinic level, to receive the usual care (n = 29), MFG (n = 34), or G-CBT (n = 26). The interventions were delivered over 3 months. Overall, the mean percentage attendance for the 10 G-CBT and MFG sessions was 87.7% and 90.2%, respectively. Three ALHIV were lost to follow-up, while 1 child died. Adherence was assessed using pharmacy records collected at baseline and 4 additional pharmacy visits. We used mixed-effects logistic regression analysis to examine the effect of the interventions on ART adherence. RESULTS We found statistically significant main effects for the intervention, χ2(2) = 7.76, p = .021, time, χ2(2) = 39.67, p < .001, and intervention-time interaction effect χ2(6)= 27.65, p < .001. Pairwise comparisons showed increasing adherence in the MFG group compared to usual care at visit 3 (odds ratio [OR] = 4.52 [1.01-20.11], p = .047) and visit 5 (OR = 3.56 [1.42-8.91], p = .007). Also, compared to usual care, participants who received G-CBT showed higher adherence at visit 4 (OR = 2.69 [1.32-5.50], p = .007). CONCLUSIONS Our study showed preliminary evidence that G-CBT and MFG might have contributed to improved ART adherence among ALHIV. Moreover, G-CBT is a low-cost alternative to expensive individual therapy, especially in low-resource settings. The results warrant the need for more extensive studies to better understand the role of these interventions in the routine care of ALHIV. The trial is registered at ClinicalTrials.Gov (#NCT04528732).
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Affiliation(s)
- Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, USA
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Mennecier A, Matoka B, Wilfred-Tonga MM, Chunda-Liyoka C, Mwiya M, Nagot N, Molès JP, Van de Perre P, Kankasa C, King R. Facilitators and barriers to infant post-natal HIV prophylaxis, a qualitative sub-study of the PROMISE-EPI trial in Lusaka, Zambia. Front Public Health 2023; 11:1242904. [PMID: 37663847 PMCID: PMC10469758 DOI: 10.3389/fpubh.2023.1242904] [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: 06/19/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background Infant post-natal prophylaxis (PNP) is used to prevent HIV transmission through breastfeeding. The WHO edited recommendations but so far there is no consensus on the duration of prophylaxis and the type of drug used depends on national guidelines. In Zambia, the national recommendations include a three-drug prophylaxis, composed of a dispersible combined tablet of zidovudine (AZT) and lamivudine (3TC) and an oral suspension of nevirapine (NVP) for 12 weeks or until the mother's viral load is <1,000 cp/mL. The PROMISE-EPI study, modified the PNP regimen to lamivudine only, initiated at 6 weeks and continued until 12 months to all HIV exposed uninfected infants of virally unsuppressed mothers. Our aim in this analysis was to identify barriers and facilitators to this extended PNP, the keystone toward an effective prevention. Methods Individual interviews and focus group discussion (FGD) were conducted with PROMISE-EPI participants who had received prophylaxis for their children from the national program up to 6 weeks and then lamivudine oral solution in PROMISE-EPI study. Health care providers and PROMISE-EPI staff were also interviewed. Sessions were recorded, transcribed verbatim and translated from local languages into English. An initial code-book was designed and then adapted on the basis of the emerging themes, to allow a descriptive thematic analysis. Results More barriers to PNP adherence were identified with triple drug prophylaxis than with lamivudine. These barriers were related to the formulation and bitter taste of AZT/3TC tablets. The ready to use formulation and sweet taste of lamivudine syrup were appreciated by mothers. Extended PNP proposed in the PROMISE-EPI study was globally well accepted and strategies were found to increase adherence. Adherence to lamivudine appeared to be better than the mothers' adherence to their own antiretroviral therapy. Conclusion Accompanying mothers living with HIV and giving them the choice of the PNP to prevent transmission via breastfeeding (type of PNP regimen and extended PNP in non-adherent mothers), may be one of the keys to reducing the burden of pediatric HIV acquisition in low and middle income countries.
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Affiliation(s)
- Anaïs Mennecier
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Beauty Matoka
- Pediatric Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Mwiya Mwiya
- Pediatric Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Jean-Pierre Molès
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Chipepo Kankasa
- Pediatric Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Rachel King
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
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Kizito S, Nabayinda J, Neilands TB, Kiyingi J, Namuwonge F, Damulira C, Nabunya P, Nattabi J, Ssewamala FM. A Structural Equation Model of the Impact of a Family-Based Economic Intervention on Antiretroviral Therapy Adherence Among Adolescents Living With HIV in Uganda. J Adolesc Health 2023; 72:S41-S50. [PMID: 37062583 PMCID: PMC10161872 DOI: 10.1016/j.jadohealth.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/28/2022] [Accepted: 12/05/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE Antiretroviral therapy (ART) adherence among adolescents living with HIV (ALWHIV) is low, with poverty remaining a significant contributor. We examined the mediation pathways between an economic empowerment intervention and ART adherence among ALWHIV. METHODS This cluster-randomized controlled trial (2012-2018) recruited 702 ALWHIV aged 10-16 in Uganda between January 2014 and December 2015. We randomized 39 clinics into the control (n = 344) or intervention group (n = 358). The intervention comprised a child development account, four microenterprise workshops, and 12 mentorship sessions. We used six self-reported items to measure adherence at 24 months, 36 months, and 48 months. We used structural equation modeling to assess the mediation effects through mental health and adherence self-efficacy, on adherence. We ran models corresponding to the 24, 36, and 48 months of follow-up. RESULTS The mean age of the participants was 12 years, and 56% were female. At 36 (model 2) and 48 months (model 3), the intervention had a significant indirect effect on ART adherence [B = 0.069, β = 0.039 (95% confidence interval [CI]: 0.005-0.074)], and [B = 0.068, β = 0.040 (95% CI: 0.010-0.116)], respectively. In both models, there was a specific mediation effect through mental health [B = 0.070, β = 0.040 (95% CI: 0.007-0.063)], and [B = 0.039, β = 0.040 (95% CI: 0.020-0.117)]. Overall, 49.1%, 90.7%, and 36.8% of the total effects were mediated in models, 1, 2, and 3, respectively. DISCUSSION EE interventions improve adherence, by improving mental health functioning. These findings warrant the need to incorporate components that address mental health challenges in programs targeting poverty to improve ART adherence in low-income settings.
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Affiliation(s)
- Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Josephine Nabayinda
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten B Neilands
- Division of Prevention Science, University of California, San Francisco, California
| | - Joshua Kiyingi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Christopher Damulira
- Division of Prevention Science, University of California, San Francisco, California
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Jennifer Nattabi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri.
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Ramphisa MJ, Rasweswe MM, Mooa RS, Seretlo RJ. The support systems offered by the sexual partners of people living with HIV / AIDS: A qualitative study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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Saya U, MacCarthy S, Mukasa B, Wabukala P, Lunkuse L, Wagner Z, Linnemayr S. "The one who doesn't take ART medication has no wealth at all and no purpose on Earth" - a qualitative assessment of how HIV-positive adults in Uganda understand the health and wealth-related benefits of ART. BMC Public Health 2022; 22:1056. [PMID: 35619119 PMCID: PMC9137215 DOI: 10.1186/s12889-022-13461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Increases in life expectancy from antiretroviral therapy (ART) may influence future health and wealth among people living with HIV (PLWH). What remains unknown is how PLWH in care perceive the benefits of ART adherence, particularly in terms of improving health and wealth in the short and long-term at the individual, household, and structural levels. Understanding future-oriented attitudes towards ART may help policymakers tailor care and treatment programs with both short and long-term-term health benefits in mind, to improve HIV-related outcomes for PLWH. METHODS In this qualitative study, we conducted semi-structured interviews among a subsample of 40 PLWH in care at a clinic in Uganda participating in a randomized clinical trial for treatment adherence in Uganda (clinicaltrials.gov: NCT03494777). Interviews were transcribed verbatim and translated from Luganda into English. Two co-authors independently reviewed transcripts, developed a detailed codebook, achieved 93% agreement on double-coded interviews, and analyzed data using inductive and deductive content analysis. Applying the social-ecological framework at the individual, household, and structural levels, we examined how PLWH perceived health and wealth-related benefits to ART. RESULTS Our findings revealed several benefits of ART expressed by PLWH, going beyond the short-term health benefits to also include long-term economic benefits. Such benefits largely focused on the ability of PLWH to live longer and be physically and mentally healthy, while also fulfilling responsibilities at the individual level pertaining to themselves (especially in terms of positive long-term habits and motivation to work harder), at the household level pertaining to others (such as improved relations with family and friends), and at the structural level pertaining to society (in terms of reduced stigma, increased comfort in disclosure, and higher levels of civic responsibility). CONCLUSIONS PLWH consider short and long-term health benefits of ART. Programming designed to shape ART uptake and increase adherence should emphasize the broader benefits of ART at various levels. Having such benefits directly integrated into the design of clinic-based HIV interventions can be useful especially for PLWH who face competing interests to increase medication adherence. These benefits can ultimately help providers and policymakers better understand PLWH's decision-making as it relates to improving ART-related outcomes.
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Affiliation(s)
- Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA.
- RAND Corporation, Santa Monica, CA, 90401, USA.
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health, 227, Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35233, USA
| | | | | | | | - Zachary Wagner
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA
- RAND Corporation, Santa Monica, CA, 90401, USA
| | - Sebastian Linnemayr
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA
- RAND Corporation, Santa Monica, CA, 90401, USA
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Opoku MP, Torgbenu EL, J-F, Nketsia W, Mprah WK, Edusei AK. Living with HIV in Ghana: Disclosure of status and experiences of persons receiving antiretroviral therapy. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:204-213. [PMID: 34517791 DOI: 10.2989/16085906.2021.1964546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Barriers to treatment faced by people living with HIV (PLWH) have been well explored in the literature. Despite the importance of antiretroviral therapy (ART) in the treatment of HIV and prevention of AIDS, in the Ghanaian context only about 32% of infected persons have access to treatment. This underscores a need to understand the experiences of PLWH receiving ART to provide baseline information for policymakers' efforts to increase access to treatment. This study captures the voices of PLWH who were receiving ART in Ghana. A total of 35 participants receiving treatment in a hospital setting (11 males, 24 females; mean age 38 years, age range 21-60 years) took part in semi-structured face-to-face interviews to discuss their opinions about the cause of their HIV infection and its impact on their lives. The study found that the participants were susceptible to discrimination in their communities and at health care facilities. Some participants experienced marriage breakdowns, unemployment, social isolation, and were unable to perform everyday chores and responsibilities. Concerted efforts to address the barriers to treatment faced by PLWH are needed.
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Affiliation(s)
- Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, Al Ain, United Arab Emirates.,School of Education, University of Tasmania, Launceston, Australia
| | | | - J-F
- School of Education, University of Tasmania, Launceston, Australia.,Faculty of Education, Crandall University, Moncton, New Brunswick, Canada
| | - William Nketsia
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Applied Sciences, Ho, Ghana.,School of Education, Western Sydney University, Sydney, Australia
| | - Wisdom Kwadwo Mprah
- Centre for Disability Rehabilitation Studies, Department of Health Promotion, Disability Studies and Education, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Kweku Edusei
- Centre for Disability Rehabilitation Studies, Department of Health Promotion, Disability Studies and Education, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Becker N, Poudel KC, Cordeiro LS, Sayer AG, Sibiya TE, Sibeko LN. A quantitative analysis of food insecurity and other barriers associated with ART nonadherence among women in rural communities of Eswatini. PLoS One 2021; 16:e0256277. [PMID: 34437585 PMCID: PMC8389413 DOI: 10.1371/journal.pone.0256277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Eswatini has the highest global prevalence of HIV despite decades of universal access to free antiretroviral therapy (ART). We conducted a mixed methods study to investigate barriers to ART adherence among women living with HIV (WLHIV) in rural communities of Eswatini. Qualitative findings were reported in our previous publication. This subsequent paper expands on our qualitative analysis to examine the magnitude to which identified barriers impacted ART adherence among WLHIV in the same communities. Methods We used an exploratory sequential design to collect data from WLHIV (n = 166) in rural Eswatini. Quantitative data were collected using interviewer-administered survey questionnaires between October and November 2017. ART adherence was measured using the CASE Adherence Index, with scores less than 10 indicating nonadherence. Log-binomial regression models were used to examine the extent to which critical barriers affected ART adherence among study participants. Results A majority of the women in our study (56%) were nonadherent to ART. Of the barriers identified in our prior qualitative analysis, only eight were found to be significantly associated with ART nonadherence in our quantitative analysis. These include, with adjusted risk ratios (ARR) and 95% confidence intervals (95% CI): household food insecurity (ARR: 3.16, 95% CI: 1.33–7.52), maltreatment by clinic staff (ARR: 2.67, 95% CI: 1.94–3.66), forgetfulness (ARR: 1.80, 95% CI: 1.41–2.31), stress (ARR: 1.47, 95% CI: 1.14–1.88), gossip (ARR: 1.57, 95% CI: 1.21–2.04), mode of transport (ARR: 0.59, 95% CI: 0.44–0.79), age (ARR: 0.98, 95% CI: 0.97–0.99), and lack of community support (ARR: 0.55, 95% CI: 0.35–0.85). Conclusions Among numerous barriers identified in our study, food insecurity was found to be a significant contributor toward ART nonadherence among women living with HIV in rural Eswatini. Future strategies aimed at improving ART adherence in Eswatini should include programs which provide food and nutrition support for people living with HIV, particularly rural women living in poverty.
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Affiliation(s)
- Nozipho Becker
- Department of Nutrition, University of Massachusetts, Amherst, Massachusetts, United States of America
- Department of Food and Nutrition Sciences, University of Eswatini, Luyengo, Kingdom of Eswatini
- * E-mail: ,
| | - Krishna C. Poudel
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Lorraine S. Cordeiro
- Department of Nutrition, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Aline G. Sayer
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Thokozile E. Sibiya
- Department of Food and Nutrition Sciences, University of Eswatini, Luyengo, Kingdom of Eswatini
| | - Lindiwe N. Sibeko
- Department of Nutrition, University of Massachusetts, Amherst, Massachusetts, United States of America
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Cavazos-Rehg P, Byansi W, Doroshenko C, Neilands TB, Anako N, Sensoy Bahar O, Kasson E, Nabunya P, Mellins CA, Ssewamala FM. Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+Adherence) on the mental health of adolescents living with HIV in Uganda. Soc Sci Med 2021; 280:113946. [PMID: 34020312 DOI: 10.1016/j.socscimed.2021.113946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Many adolescents living with HIV in sub-Saharan Africa (SSA) experience poverty and have access to limited resources, which can impact HIV and mental health outcomes. Few studies have analyzed the impact of economic empowerment interventions on the psychosocial wellbeing of adolescents living with HIV in low resource communities, and this study aims to examine the mediating mechanism(s) that may explain the relationship between a family economic empowerment intervention (Suubi + Adherence) and mental health outcomes for adolescents (ages 10-16 at enrollment) living with HIV in Uganda. METHOD We utilized data from Suubi + Adherence, a large-scale six-year (2012-2018) longitudinal randomized controlled trial (N = 702). Generalized structural equation models (GSEMs) were conducted to examine 6 potential mediators (HIV viral suppression, food security, family assets, and employment, HIV stigma, HIV status disclosure comfort level, and family cohesion) to determine those that may have driven the effects of the Suubi + Adherence intervention on adolescents' mental health. RESULTS Family assets and employment were the only statistically significant mediators during follow-up (β from -0.03 to -0.06), indicating that the intervention improved family assets and employment which, in turn, was associated with improved mental health. The proportion of the total effect mediated by family assets and employment was from 42.26% to 71.94%. CONCLUSIONS Given that mental health services provision is inadequate in SSA, effective interventions incorporating components related to family assets, employment, and financial stability are crucial to supporting the mental health needs of adolescents living with HIV in under-resourced countries like Uganda. Future research should work to develop the sustainability of such interventions to improve long-term mental health outcomes among this at-risk group.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA.
| | - William Byansi
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Christine Doroshenko
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Torsten B Neilands
- University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Nnenna Anako
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA; Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Claude A Mellins
- Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
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Tong PD, Atuhairwe C, Taremwa IM. <p>Differential Self-Reported Determinants to Antiretroviral Therapy Adherence: Findings from Caregivers of Children Under Five Years Living with Human Immunodeficiency Virus Infection Attending Al-Sabah Hospital, South Sudan</p>. HIV AIDS (Auckl) 2020; 12:175-186. [PMID: 32547247 PMCID: PMC7244449 DOI: 10.2147/hiv.s248057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022] Open
Abstract
Aim/Objective This study explored the caregivers’ self-reported determinants of antiretroviral therapy (ART) adherence among children under five years living with human immunodeficiency virus (HIV) infection attending Al-Sabah Hospital, South Sudan. Methods A cross-sectional study of 126 caregivers of HIV-infected children under five years was conducted at Al-Sabah Hospital, South Sudan. Data were collected using an interviewer-administered questionnaire. The self-reported adherence was measured as a binary variable using binary logistic regression. Only variables that were significant at bivariate analysis were analyzed at multivariate level and interpreted using the odds ratios (p< 0.05). Results Out of 126 caregivers with HIV-infected children, 38 (30.2%) did not adhere to ART. Of the proportion that adhered to ART (88, 69.8%), 49 (55.7%) were male. Most of the children (52, 59.1%) were above two years, but under five years. Fifty (56.8%) of those who adhered had completed 3 months on ART, and the majority were at WHO stage-1 of HIV infection. Analysis of the determinants indicated that children’s duration on ART (p=0.001), type of ART regimen (single, double or triple therapy) (p=0.065), type of work done by the caregiver to earn a living (p-value 0.003), time a child was initiated on ART (p=0.002), caregiver–child relationship (p=0.002), caregiver-spousal support (p=0.019), type of support obtained whether monetary or not (p=0.000), when the child was started on ART (p=0.004), the person administering ART (p=0.010), the type of ARVs administered (p=0.001), the caregiver detecting ART side effects (p=0.000), types of adverse effects suffered by the child (p=0.043), time of receiving ART (p=0.047), use of western medicine (p=0.043), healthcare cadre (p=0.002), the kind of attention the healthcare provider offered (p=0.015), and improvements in quality of HIV services (p=0.001) were significantly associated with ART adherence. Conclusion The study findings indicated that ART adherence among HIV-infected children under five years was suboptimal. This will necessitate continuous engagement and education of caregivers on the prominence of adhering to ART.
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Affiliation(s)
| | | | - Ivan Mugisha Taremwa
- Clarke International University, Kampala, Uganda
- Correspondence: Ivan Mugisha Taremwa Tel +256 774346368 Email
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Becker N, Cordeiro LS, Poudel KC, Sibiya TE, Sayer AG, Sibeko LN. Individual, household, and community level barriers to ART adherence among women in rural Eswatini. PLoS One 2020; 15:e0231952. [PMID: 32343742 PMCID: PMC7188206 DOI: 10.1371/journal.pone.0231952] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Despite access to free antiretroviral therapy (ART) for all people living with human immunodeficiency virus (HIV), noncompliance to treatment continues to be a significant challenge in Eswatini. Yet studies investigating barriers to ART adherence in Eswatini are scarce. Most notably, there is a lack of research regarding rural women in Eswatini, who are currently the country’s most vulnerable to HIV infection. Therefore, the objective of the study is to investigate individual, household, and community level barriers to ART adherence among rural women living with HIV. Methods We conducted a qualitative study to investigate individual, household, and community level barriers to ART adherence. We conducted focus group discussions with HIV-infected women (n = 4) from rural villages in Eswatini, and in-depth interviews with healthcare workers (n = 8) serving the area clinics. Open and axial coding techniques were used for data analysis and interpreted within a social ecological framework. Results Our findings revealed several individual level barriers including hunger, side effects of ART, personal stress, lack of disclosure of HIV status, alcohol use, and forgetting to take ART. Lack of food, unemployment and scarcity of financial resources were identified as critical barriers at the household level. Community and institutional barriers encompassed factors related to health delivery such as lack of privacy, travel time, transportation costs, excessive alcohol use by healthcare workers, maltreatment, public and self-stigma, gossip, and long waits at clinics. Conclusions Rural women living with HIV face multilevel barriers to ART adherence. Support programs aimed at increasing ART adherence among this vulnerable population need to develop targeted polices to alleviate challenges rural women face, beginning with expanding qualifications for food assistance programs.
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Affiliation(s)
- Nozipho Becker
- Department of Nutrition, University of Massachusetts, Amherst, Massachusetts, United States of America
- Department of Food and Nutrition Sciences, University of Eswatini, Luyengo, Kingdom of Eswatini
- * E-mail: ,
| | - Lorraine S. Cordeiro
- Department of Nutrition, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Krishna C. Poudel
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Thokozile E. Sibiya
- Department of Food and Nutrition Sciences, University of Eswatini, Luyengo, Kingdom of Eswatini
| | - Aline G. Sayer
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Lindiwe N. Sibeko
- Department of Nutrition, University of Massachusetts, Amherst, Massachusetts, United States of America
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11
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Ndakidemi E, Emerson C, Medley A, Ngowi B, Ng'eno B, Munuo G, Kohi W, Modi S. Health care worker perspectives on TB case finding and HIV services among pediatric TB patients in Tanzania. Int J Tuberc Lung Dis 2020; 23:811-816. [PMID: 31439112 DOI: 10.5588/ijtld.18.0445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) infection in children are of concern due to the high morbidity and mortality they engender. Tanzania is working to improve TB and HIV case identification and treatment, as well as linkage of TB and HIV care in pediatric patients.METHODS: In-depth interviews were conducted in March 2016 at 10 high TB burden clinics in five districts of Tanzania to identify the barriers to pediatric TB diagnosis and HIV care. Health care workers (HCWs) at TB clinics who provided informed consent were administered interviews which were analyzed.RESULTS: Of 41 HCWs interviewed, 26 reported receiving pediatric TB training. Barriers to TB diagnosis included low community awareness, stigma and late presentation to the clinic. Barriers to HIV testing included children attending the TB clinic with someone who was not their parent/guardian and shortages of HIV rapid test kits. HCWs stressed the need for improved community education because it was perceived that some caregivers did not understand the importance of prompt TB and HIV treatment in children (although most were eager for a resolution of their child's illness).CONCLUSIONS: Efforts are needed to ensure effective TB and HIV diagnosis and treatment of children, provision of broader HCW and community education, enhanced TB-HIV contact tracing, and ensuring a continuous supply of HIV rapid test kits.
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Affiliation(s)
- E Ndakidemi
- Infosmart Research and Consulting Tanzania, Dar es Salaam, Tanzania
| | - C Emerson
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - A Medley
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - B Ngowi
- National Institute for Medical Research Muhimbili Research Centre, Dar es Salaam
| | - B Ng'eno
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - W Kohi
- Community Development, Gender, Elderly and Children; National Tuberculosis and Leprosy Programme, Tanzania Ministry of Health, Dar es Salaam, Tanzania
| | - S Modi
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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12
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Jolly P, Padilla LA, Ahmed C, Harris C, Mthethwa N, Jha M, Ba I, Styles A, Hope SP, Brooks R, Naluyinda-Kitabire F, Mamba M, Preko P. Barriers to antiretroviral therapy initiation for HIV-positive children aged 2-18 months in Swaziland. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 17:193-202. [PMID: 30003844 DOI: 10.2989/16085906.2018.1488266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although early antiretroviral therapy (ART) reduces HIV-related mortality in children by up to 75%, almost half of HIV-positive children younger than 1 year old in Swaziland do not initiate ART. This study was conducted to identify barriers to early ART initiation among HIV-positive infants. This was a case-control study among HIV-positive infants, aged 2 to 18 months, who either did not initiate ART (cases), or initiated ART (controls), during 18 months after testing. Multivariable logistic regression showed that infants who visited the clinic every month, or every 2 months, were 5.78 and 6.20 times more likely to initiate ART than those who visited less often (OR 5.78, 95% CI 1.82-18.33 and OR 6.20, 95% CI 1.30-29.60 respectively). Children who lived ≤30 and 31-60 minutes from the nearest clinic were 84% and 79% less likely respectively to initiate ART (OR 0.16, 95% CI 0.03-0.78 and OR 0.21, 95% CI 0.04-0.98) compared with those who lived more than 60 minutes away. Children who received immunisation after 6 months were 22.59 times more likely to initiate ART (OR 22.59, 95% CI 7.00-21.72) than those who did not. Infants of caregivers who had excellent or good relationships with their healthcare provider were 4.32 times more likely to initiate ART (OR 4.32, 95% CI 1.01-18.59) than those of caregivers who had average or poor relationships with healthcare providers. The significant predictors of ART initiation identified in this study should be regarded as priority areas for intervention among HIV-positive women in Swaziland.
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Affiliation(s)
- Pauline Jolly
- a University of Alabama at Birmingham School of Public Health , Birmingham , Alabama , USA
| | - Luz A Padilla
- a University of Alabama at Birmingham School of Public Health , Birmingham , Alabama , USA
| | - Charisse Ahmed
- a University of Alabama at Birmingham School of Public Health , Birmingham , Alabama , USA
| | - Chantal Harris
- a University of Alabama at Birmingham School of Public Health , Birmingham , Alabama , USA
| | - Nobuhle Mthethwa
- b Swaziland National AIDS Programme, National Pediatric HIV Care & Treatment Office , Mbabane , Swaziland
| | - Megha Jha
- a University of Alabama at Birmingham School of Public Health , Birmingham , Alabama , USA
| | - Inessa Ba
- c Clinton Health Access Initiative , Mbabane , Swaziland
| | - Amy Styles
- d Eureka Idea Company , Perth , Australia
| | - Sarah P Hope
- e Baylor International Pediatric AIDS Initiative , Mbabane , Swaziland
| | - Raina Brooks
- a University of Alabama at Birmingham School of Public Health , Birmingham , Alabama , USA
| | | | - Makhosini Mamba
- f United Nations Children's Fund (UNICEF) , Mbabane , Swaziland
| | - Peter Preko
- g President Emergency Plan for AIDS Relief (PEPFAR) , Mbabane , Swaziland
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