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Shimbre MS, Bodicha BB, Gabriel ANA, Ghazal L, Jiao K, Ma W. Barriers and facilitators of transition of adolescents living with HIV into adult care in under-resourced settings of Southern Ethiopia: a qualitative study. BMC Public Health 2024; 24:2800. [PMID: 39396968 PMCID: PMC11472466 DOI: 10.1186/s12889-024-20338-7] [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: 09/16/2023] [Accepted: 10/09/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Adolescence is commonly perceived as a distinct and typically healthy stage of life. However, in regions with a high prevalence of HIV, like Ethiopia, numerous adolescents are contracting the virus. Upon testing and diagnosis, they encounter care-related issues, particularly barriers and facilitators of the healthcare transition from adolescent to adult clinics. Hence, the study aimed to investigate the barriers and facilitators influencing the transition of adolescents living with HIV (ALWHs) in the resource-limited settings of Southern Ethiopia. METHODS The research employed a phenomenological study design with a qualitative methodology. Purposive sampling was used to gather data through in-depth interviews (IDIs) and focus group discussions (FDGs) involving ALWHs and their parents. The data analysis followed Van Manen's principles. RESULTS Following Van Manen's guidelines, the data analysis revealed a conceptual framework with two major themes: "Barriers" and "Facilitators". The theme barrier was derived from three sub-themes including behavioral barriers, social barriers, and system barriers in the transition. The theme facilitator was derived from four sub-themes including self-acceptance as an adult, a desire to experience new things, a supportive family, and friendly healthcare services. The study identified three levels of factors influencing the transition into adult clinics: individual, family/peer, and healthcare-related factors. The barriers to transition included lack of knowledge, being in a romantic relationship, psychosocial struggles, perceiving us as immature, stigma, negative peer pressure, lack of timely disclosure, absence of transition guidelines, disrespectful treatment, and absence of separate clinics. On the other hand, facilitators such as self-acceptance as an adult, desire for new experiences, family support, informed support and promising outcomes, flexible appointment scheduling, and psycho-social support groups were found to improve the transition process and enhance the overall well-being of adolescents living with HIV. CONCLUSION The study highlights the complex transition process for ALWHs into adult healthcare. Barriers such as lack of knowledge, stigma, and disrespectful treatment pose challenges during this critical period. Conversely, facilitators like self-acceptance, family support, and youth-friendly healthcare services can enhance the transition experience and well-being of ALWHs. Collaborative efforts among ALWHs, families, and healthcare providers are crucial for successful transitions and improved health outcomes. Separated clinics catering to the unique needs of ALWHs are recommended to address privacy concerns.
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Affiliation(s)
- Mulugeta Shegaze Shimbre
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Belay Boda Bodicha
- Department of Biomedical Sciences, School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | - Lubna Ghazal
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Keldi Jiao
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Wei Ma
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
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Folgosi VÂ, Komninakis SV, Lopes L, Monteiro MA, Assone T, Fonseca LAM, Domingues W, Leite PD, Victor JR, Casseb J. Unraveling clinical outcomes of long-term cART treatment in HIV-1 patients with or without the Brazilian GWGR motif in the V3 loop. Rev Inst Med Trop Sao Paulo 2024; 66:e38. [PMID: 39052025 PMCID: PMC11251515 DOI: 10.1590/s1678-9946202466038] [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: 02/15/2024] [Accepted: 05/06/2024] [Indexed: 07/27/2024] Open
Abstract
The presence of genetic mutations in HIV poses a significant challenge, potentially leading to antiretroviral resistance and hampering therapeutic development. The Brazilian population has presented variations in the HIV envelope V3 loop gene, especially the GWGR motif. This motif has been linked to reduced transmission potential and slower CD4+ T cell decline. This study aimed to assess clinical outcomes in patients with HIV-1 infected with strains containing the GWGR motif compared with those without it during long-term cART. A cohort of 295 patients with HIV was examined for the GWGR motif presence in the V3 loop. A total of 58 samples showed the GWGR signature, while 237 had other signatures. Multifactorial analyses showed no significant differences in demographic characteristics, CD4+ cell count, AIDS progression, or mortality between GWGR carriers and others. However, the mean interval between the first positive HIV test and the initial AIDS-defining event was more than two times longer for women carrying the GWGR signature (p = 0.0231). We emphasize the positive impact of cART on HIV/AIDS treatment, including viral suppression, CD4+ cell preservation, and immune function maintenance. Although no significant differences were found during cART, residual outcomes reflecting adherence challenges were observed between diagnosis and the first AIDS-defining event. The previously described outcomes, highlighting statistically significant differences between individuals carrying the GPGR motif compared with those with the Brazilian GWGR motif, may be directly linked to the natural progression of infection before advancements in cART. Presently, these physicochemical aspects may no longer hold the same relevance.
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Affiliation(s)
- Victor Ângelo Folgosi
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
| | - Shirley Vasconcelos Komninakis
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo, Laboratório de Retrovirologia,
São Paulo, São Paulo, Brazil
| | - Luciano Lopes
- Universidade Federal de São Paulo, Departamento de Informática em
Saúde, Divisão de Bioinformática e Ciência de Dados em Biologia, São Paulo, São
Paulo, Brazil
| | - Mariana Amélia Monteiro
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
| | - Tatiane Assone
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
| | - Luiz Augusto Marcondes Fonseca
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
| | - Wilson Domingues
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
| | - Pedro Domingos Leite
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
| | - Jefferson Russo Victor
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
- Universidade Santo Amaro, Programa de Pós-Graduação em Ciências da
Saúde, São Paulo, São Paulo, Brazil
| | - Jorge Casseb
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM-56), São
Paulo, São Paulo, Brazil
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Evangeli M, Gnan G, Musiime V, Fidler S, Seeley J, Frize G, Uwizera A, Lisi M, Foster C. The HIV Empowering Adults' Decisions to Share: UK/Uganda (HEADS-UP) Study-A Randomised Feasibility Trial of an HIV Disclosure Intervention for Young Adults with Perinatally Acquired HIV. AIDS Behav 2024; 28:1947-1964. [PMID: 38491226 PMCID: PMC11161430 DOI: 10.1007/s10461-024-04294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/18/2024]
Abstract
Young adults with perinatally acquired HIV (PAH) face numerous challenges, including antiretroviral therapy (ART) adherence, managing onward HIV transmission risks and maintaining wellbeing. Sharing one's HIV status with others (onward HIV disclosure) may assist with these challenges but this is difficult. We developed and tested the feasibility of an intervention to help HIV status sharing decision-making for young adults with PAH. The study used a randomised parallel group feasibility design with 18-25-year-olds in Uganda and 18-29 year-olds in the UK. Participants were randomly assigned to intervention or standard of care (SOC) condition. The intervention consisted of four sessions (3 group, 1 individual) with follow-up support, delivered in person in Uganda and remotely in the UK. Assessments were carried out at: Pre-intervention /baseline; Post-intervention (intervention group only); Six-month follow-up. 142 participants were recruited (94 Uganda, 48 UK; 89 female, 53 male). At six-month follow-up, 92/94 (98%) participants were retained in Uganda, 25/48 (52%) in the UK. Multivariate analysis of combined data from both countries, showed a non-significant effect of intervention condition on HIV disclosure cognitions and affect (p = 0.08) and HIV disclosure intention (p = 0.09). There was a significant intervention effect on well-being (p = 0.005). This study addressed important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH across two very different settings. The intervention was acceptable in both countries and feasible in Uganda. In the UK, retention may have been affected by its remote delivery.Trial registration: ISRCTN Registry, ISRCTN31852047, Registered on 21 January 2019.
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Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
| | - Georgina Gnan
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Victor Musiime
- Makerere University, Kampala, Uganda
- Joint Clinical Research Centre, Kampala, Uganda
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, Imperial College NIHR BRC, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Graham Frize
- Central and North West London NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Matteo Lisi
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
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Henderson M, Fidler S, Foster C. Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps. Trop Med Infect Dis 2024; 9:74. [PMID: 38668535 PMCID: PMC11053933 DOI: 10.3390/tropicalmed9040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
In resourced settings, adults living with perinatally acquired HIV are approaching the 5th decade of life. Their clinical and psychological outcomes highlight potential future issues for the much larger number of adolescents growing up with HIV in sub-Saharan Africa, and will inform the development of appropriate healthcare services. Lifelong exposure to HIV, and increasingly to antiretroviral therapy throughout growth and development, contrasts with adults acquiring HIV in later life. This review describes the clinical outcomes for adults living with perinatally acquired HIV including post transition mortality, morbidity and retention in care. Rates of viral suppression, drug resistance and immunological function are explored. Co-morbidities focus on metabolic, cardiovascular, respiratory and bone health with quality-of-life data including neurocognitive functioning and mental health. Sexual and reproductive health including vaccine-preventable disease and the prevention of onward transmission to partners and infants are considered. The data gaps and future research questions to optimise outcomes for this emerging adult cohort are highlighted.
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Affiliation(s)
- Merle Henderson
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Sarah Fidler
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Caroline Foster
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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Smith T, Seeley J, Shahmanesh M, Psaros C, Munikwa C, Ngwenya N. Influences on decision-making about disclosure of HIV status by adolescents and young adults living with HIV in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:306-315. [PMID: 38117742 DOI: 10.2989/16085906.2023.2277358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
Background: Adolescents and young adults living with HIV (AYA) are faced with the challenge of living with a life-long chronic condition. We investigated the influences on the decisions by AYA to disclose their HIV status to family, intimate partners and friends.Methods: Twenty AYA aged between 15 and 24 years were purposely selected through local community-based organisations in eThekwini municipality and uMkhanyakude district in KwaZulu-Natal Province, South Africa. Virtual in-depth interviews were conducted between September 2020 to October 2021 using a topic guide focusing on HIV-status disclosure and the impact of stigma on decision-making capacity. An iterative thematic process was used for analysis.Results: Findings revealed the challenges that AYA experience for disclosure because of stigma and how this impacts their decision-making capacity. Family and friends influenced AYA in processing their discovery of their HIV status offering support needed to manage living with HIV. However, for some AYA disclosing to relatives, friends and intimate partners was difficult because of fears of rejection and recrimination. The act of disclosure was influenced by both internalised and external stigma and the type of relationships and interactions that AYA had with relatives, friends and caregivers.Conclusions: The decision to disclose is challenging for AYA because of the fear of rejection, along with internal and external stigma. The provision of support, whether from family or peers, is important. Enhancing the decision-making capacity of AYA is essential for developing their self-esteem as well as supporting future healthcare choices.
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Affiliation(s)
- Thandeka Smith
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Christina Psaros
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | - Nothando Ngwenya
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
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