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Masa R, Zimba M, Zimba G, Zulu G, Zulu J, Operario D. The Association of Emotional Support, HIV Stigma, and Home Environment With Disclosure Efficacy and Perceived Disclosure Outcomes in Young People Living With HIV in Zambia: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2024; 35:17-26. [PMID: 37994517 PMCID: PMC10842355 DOI: 10.1097/jnc.0000000000000442] [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] [Indexed: 11/24/2023]
Abstract
ABSTRACT This study examined the association of various forms of social support, attitudes toward living at home, and HIV stigma experiences with HIV self-disclosure efficacy and perceived negative disclosure outcomes. We analyzed cross-sectional data from 120 young people with HIV (YPWH) aged 18-21 years receiving outpatient care in Eastern Province, Zambia. Perceived negative disclosure outcomes and disclosure self-efficacy were measured using an adapted version of the Adolescent HIV Disclosure Cognitions and Affect Scale. Explanatory variables included parental or caregiver support, emotional support, instrumental support, HIV stigma experiences, and attitudes toward living at home. Findings suggest that YPWH's confidence in their ability to self-disclose their HIV status and their assessment of negative outcomes associated with HIV disclosure are influenced by emotional support, experiences of HIV stigma, and the quality of the home environment.
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Affiliation(s)
- Rainier Masa
- Rainier Masa, PhD, is an Associate Professor, School of Social Work University of North Carolina, Chapel Hill, North Carolina, USA. Mathias Zimba, MA, is a Director, Rising Fountains Development Program, Chipata, Zambia. Gilbert Zimba, DipTh, is Project Coordinator, Rising Fountains Development Program, Lundazi, Zambia. Graham Zulu, MSW, is a Research Associate, Global Social Development Innovations, University of North Carolina, Chapel Hill, North Carolina, USA. Joseph Zulu, PhD, is an Associate Professor, School of Public Health, University of Zambia, Lusaka, Zambia. Don Operario, PhD, is a Professor, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Ismail R, Yona S, Nurachmah E, Khariroh S, Sujianto U, Santoso W, Bangun SA, Voss JG. Feasibility of Lantern Using WhatsApp to Improve Antiretroviral Therapy Adherence. Comput Inform Nurs 2023; 41:915-920. [PMID: 37580048 DOI: 10.1097/cin.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
This pilot study tested the feasibility of Lantern program, an adherence program to HIV medications using WhatsApp, a secure social media messaging application from Meta, for a smartphone-based platform to enhance medication-taking adherence of antiretroviral therapy among people living with HIV in Indonesia. Thirty participants were recruited for this 8-week study. We recruited persons if they had taken antiretroviral therapy for at least 3 months prior to the study, had a smartphone, Internet access, and could use Lantern with WhatsApp. Here, we report the results from the focus group discussions, with the participants evaluating the qualitative aspects of the experiences. The WhatsApp platform was found to be safe, practical, and relatively inexpensive and provided confidentiality for the participants. Three themes emerged from the focus groups: the study motivated participants to take their antiretroviral therapy medications on time, they still set medication reminder alarms, and being in the study made them feel supported. The Lantern program indicated good feasibility and acceptability for adherence to antiretroviral therapies among people living with HIV. Future research should examine on how community organizations and healthcare providers can take advantage of the WhatsApp program to improve adherence to antiretroviral therapies.
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Affiliation(s)
- Rita Ismail
- Author Affiliations: Faculty of Health Sciences, Universitas Pembangunan Nasional Veteran Jakarta (Dr Ismail); Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Jawa Barat (Drs Yona and Nurachmah); Stikes Hang Tuah Tanjung Pinang, Tanjung Pinang, Kepulauan Riau (Dr. Khariroh); Department Ilmu Keperawatan, Fakultas Kedokteran, Universitas Dipanegoro, Semarang, Jawa Tengah (Dr. Sujianto); Stikes Bina Sehat PPNI Mojokerto, Mojokerto, Jawa Timur (Dr. Santoso); and Ministry of Health Republic of Indonesia, Poltekkes Kemenkes Jakarta III, Jakarta (Mr Bangun), Indonesia; and Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Dr Voss)
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Healy E, O’Malley G, Mugo C, Kaggiah A, Seeh D, Muriithi A, Lopez AR, Kumar M, Guthrie B, Moreno M, John-Stewart G, Inwani I, Ronen K. "Whenever you need support, you first turn to the group": motivations and functions of WhatsApp groups for youth living with HIV. AIDS Care 2023; 35:437-446. [PMID: 35761786 PMCID: PMC9792620 DOI: 10.1080/09540121.2022.2088680] [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: 06/08/2021] [Accepted: 06/07/2022] [Indexed: 12/30/2022]
Abstract
Social support is a critical component of achieving positive health outcomes for youth living with HIV (YLWH). Mobile health (mHealth) has significant potential for providing social support to YLWH. However, little is known about the domains of social support most needed by YLWH which mHealth interventions might address. Drawing on the spontaneous creation of WhatsApp support groups by YLWH in Nairobi, Kenya, we characterized Kenyan YLWH's social support needs and potential roles of social media groups in meeting them. We conducted interviews and focus-groups with 68 YLWH, 24 caregivers and 20 healthcare workers, and observed two YLWH-led WhatsApp groups for 6 weeks. Youth reported that existing support systems, including family and healthcare workers, already provided informational and instrumental support. However, they emphasized unmet companionship and emotional support needs, leading to isolation, hopelessness, and medication adherence challenges. Participants identified connection with other YLWH as a unique source of emotional and companionship support that allowed them to feel more secure and less isolated. Interviews and observed WhatsApp chats demonstrated that WhatsApp groups were a desirable medium for companionship support that overcame barriers to in-person connection.
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Affiliation(s)
- Elise Healy
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | - Cyrus Mugo
- University of Washington, Department of Global Health, Seattle, WA, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - David Seeh
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Alana R Lopez
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | - Brandon Guthrie
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | | | | | - Keshet Ronen
- University of Washington, Department of Global Health, Seattle, WA, USA
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Panneh M, Gafos M, Nyariki E, Liku J, Shah P, Wanjiru R, Wanjiru M, Beksinska A, Pollock J, Jama Z, Babu H, Kaul R, Seeley J, Bradley J, Kimani J, Beattie T. Mental health challenges and perceived risks among female sex Workers in Nairobi, Kenya. BMC Public Health 2022; 22:2158. [PMID: 36418973 PMCID: PMC9685887 DOI: 10.1186/s12889-022-14527-5] [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: 05/26/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) in Kenya are at an increased risk of violence, poverty, police arrest, and problematic alcohol and other substance use, all of which are linked to poor mental health and suicidal ideation. Despite the psychological stressors experienced by FSWs, there is no published qualitative methods research investigating their mental health experiences in Kenya. In this paper, we draw on data from in-depth interviews to examine FSWs' lifetime mental health experiences and perceived risk factors. METHODS We used baseline in-depth interviews of the Maisha Fiti longitudinal study of FSWs in Nairobi. We randomly selected 40 FSWs from 1003 FSWs who attended a baseline behavioural-biological interview as part of the Maisha Fiti study. The interview guide was semi-structured, and participants were asked to detail their life stories, including narrating specific events such as entry into sex work, experiences of violence, mental health experiences, and use of alcohol and other substances. Interviews were recorded in Kiswahili/ English and transcribed in English. Data were coded and thematically analysed in Nvivo (v.12). RESULTS Results indicated that the majority of participants understood 'mental health' as 'insanity', 'stress', 'depression', and 'suicide'; nevertheless, a number described mental health symptomatically, while a few believed that mental health problems were caused by witchcraft. Interestingly, poverty, low levels of education, poor job opportunities, a lack of family support, harmful gender norms, intimate partner violence and subsequent relationship breakdowns, and family bereavement all contributed to poor mental health and subsequent entry into sex work. In addition, the consequences of sex work such as sexual risks, and ongoing violence from police and clients, further exacerbated poor mental health. CONCLUSIONS There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for 'at-risk' populations such as FSWs should enhance coping strategies and help-seeking efficacy.
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Affiliation(s)
- Mamtuti Panneh
- LSHTM, Department for Global Health and Development, London, UK.
| | - Mitzy Gafos
- LSHTM, Department for Global Health and Development, London, UK
| | - Emily Nyariki
- LSHTM, Department for Global Health and Development, London, UK
| | - Jennifer Liku
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Pooja Shah
- LSHTM, Department for Global Health and Development, London, UK
| | - Rhoda Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | | | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- LSHTM, Department for Global Health and Development, London, UK
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Janet Seeley
- LSHTM, Department for Global Health and Development, London, UK
| | - John Bradley
- MRC International Statistics and Epidemiology Group, Department for Infectious Disease Epidemiology, LSHTM, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tara Beattie
- LSHTM, Department for Global Health and Development, London, UK
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Nardell MF, Hedt-Gauthier B, Earnshaw VA, Bogart LM, Dietrich JJ, Courtney I, Tshabalala G, Bor J, Orrell C, Gray G, Bangsberg DR, Katz IT. Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines. AIDS Behav 2022; 26:1366-1376. [PMID: 34705150 PMCID: PMC9007825 DOI: 10.1007/s10461-021-03493-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/06/2023]
Abstract
Some people with HIV (PWH) test positive multiple times without initiating antiretroviral therapy (ART). We surveyed 496 ART-eligible PWH following routine HIV testing at three clinics in Soweto and Gugulethu, South Africa in 2014-2015. Among repeat positive testers (RPTs) in this cohort, we compared rates of treatment initiation by prior treatment eligibility and assessed psychosocial predictors of treatment initiation in logistic regression models. RPTs represented 33.8% of PWH in this cohort. Less than half of those who reported eligibility for ART on prior testing started treatment upon retesting, in contrast to two thirds of RPTs who were previously ineligible for treatment who started treatment once they learned of their eligibility. Those who reported coping through substance use were more likely to decline treatment versus those not using substances. PWH who test repeatedly represent a vulnerable population at risk for ART non-initiation who may benefit from interventions addressing individualized coping strategies.
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Affiliation(s)
- Maria F Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Thorn Building 14th Floor, Boston, MA, 02120, USA.
- Harvard Medical School, Boston, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, USA.
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Massachusetts General Hospital Center for Global Health, Boston, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, USA
| | | | - Janan J Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Western Cape, South Africa
| | - Ingrid Courtney
- Desmond Tutu Health Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Gugulethu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Western Cape, South Africa
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
| | - Ingrid T Katz
- Harvard Medical School, Boston, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, USA
- Massachusetts General Hospital Center for Global Health, Boston, USA
- Harvard Global Health Institute, Cambridge, USA
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Nuraidah, Wanda D, Hayati H, Rachmawati IN, Waluyo A. "I can live a normal life": Exploring adherence to antiretroviral therapy in Indonesian adolescents living with HIV. BELITUNG NURSING JOURNAL 2022; 8:108-114. [PMID: 37521893 PMCID: PMC10386811 DOI: 10.33546/bnj.2024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/13/2022] [Accepted: 03/23/2022] [Indexed: 08/01/2023] Open
Abstract
Background Adherence to antiretroviral therapy (ART) can be challenging since it needs to be continued for a lifetime. At their age, adolescents start to be responsible for their life, and this continued therapy might be a challenge for them. Objective This study explored the experiences of adherence to ART in adolescents living with HIV in Jakarta, Indonesia. Methods A qualitative study with an Appreciative Inquiry (AI) approach was employed to explore challenges adolescents face in ART adherence which focused more on positive aspects of the experience. In-depth interviews were conducted with ten adolescents who were selected purposively based on criteria including those aged 13-19 years, having been diagnosed with HIV infection and receiving ART for more than a year, and never having discontinued ART. All participants were registered in the outpatient clinic in one top referral hospital in Jakarta. The data were analyzed using thematic analysis. Results Five themes were identified from the data: living a normal life, wanting to be healthy, taking medication on time, challenges in undergoing treatment, and there is hope. Conclusion Adolescents with HIV want to live as normal and healthy as possible, like other adolescents. Even though adolescents face several challenges to comply with ART, they try to take the medication as prescribed. The findings of this study serve as input for nurses to maintain compliance with ARVs in adolescents who have HIV.
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Affiliation(s)
- Nuraidah
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Dessie Wanda
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Happy Hayati
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Imami Nur Rachmawati
- Department of Maternity Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Agung Waluyo
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
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McGowan M, Roche SD, Nakitende A, Wachinger J, Nanyiri E, Amongin J, Nakabuye A, Musoke DK, McMahon SA, Bӓrnighausen T, Ortblad KF. Understanding how social support influences peer-delivered HIV prevention interventions among Ugandan female sex workers: a case study from HIV self-testing. BMC Public Health 2022; 22:427. [PMID: 35241042 PMCID: PMC8895611 DOI: 10.1186/s12889-022-12836-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/21/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Female sex workers (FSWs) have tightly connected peer networks and remain at high risk of HIV acquisition. Peer delivery of HIV prevention interventions, such as HIV self-testing (HIVST), is a recommended implementation strategy for increasing intervention uptake and continuation among FSWs. We analyzed qualitative data from a peer-delivered HIVST intervention among FSWs in urban Uganda to understand the ways social support within this peer network can motivate or discourage the uptake of peer-delivered HIVST. METHODS Between February and April 2017, we conducted in-depth interviews (IDIs) with FSWs (n = 30) and focus group discussions (FGDs) with FSW peer educators (PEs, n = 5) finishing participation in a four-month randomized implementation trial testing models of peer-delivered HIVST in Kampala. FSW participants were ≥ 18 years old, self-reported exchanging sex for money or goods (past month) and had not recently tested for HIV (past 3 months). FSW PEs either directly distributed HIVST kits to participants or provided coupons exchangeable for HIVST kits from specified healthcare facilities. In the IDIs and FGDs, we asked participants to share their experiences receiving or delivering peer-delivered HIVST, respectively. Using a hybrid deductive and inductive coding approach, we arranged findings along the dimensions of an established social support theory: informational, instrumental, and emotional support. RESULTS The median age of participants was 30 years (IQR: 27-33) and PEs was 33 years (IQR: 29-37). We found that social support within FSW peer networks both motivated and discouraged uptake of peer-delivered HIVST. For example, sharing positive HIVST experiences (informational support), directly delivering HIVST kits (instrumental support), and encouraging linkage to care (emotional support) motivated HIVST uptake among FSWs. Conversely, the spread of misinformation (informational support), limited HIVST kit availability fostering mistrust of PEs (instrumental support), and fear of social exclusion following HIV status disclosure (emotional support) discouraged HIVST uptake among FSWs. CONCLUSIONS In Uganda, social support (e.g., informational, instrumental, and emotional support) among FSW peers can work in ways that both motivate and discourage peer-delivered intervention uptake. Future FSW peer-delivered HIV prevention interventions should be designed around the dimensions of social support within FSW peer networks to maximize initial and repeat intervention delivery and uptake.
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Affiliation(s)
- Maureen McGowan
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Stephanie D Roche
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | | | - Jonas Wachinger
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | | | | | | | | | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Till Bӓrnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
- Africa Health Research Institute, Somkhele and Durban, South Africa
| | - Katrina F Ortblad
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
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Nakandi RM, Kiconco P, Musiimenta A, Bwengye JJ, Nalugya S, Kyomugisa R, Obua C, Atukunda EC. Understanding patterns of family support and its role on viral load suppression among youth living with HIV aged 15 to 24 years in southwestern Uganda. Health Sci Rep 2022; 5:e467. [PMID: 35229040 PMCID: PMC8865062 DOI: 10.1002/hsr2.467] [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: 03/08/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Active family support helps as a buffer against adverse life events associated with antiretroviral therapy (ART) uptake and adherence. There is limited data available to explain how family support shapes and affects individual healthcare choices, decisions, experiences, and health outcomes among youth living with HIV (YLWH). We aimed to describe family support patterns and its role in viral load suppression among YLWH at a rural hospital in southwestern Uganda. METHODS We performed a mixed-method cross-sectional study between March and September 2020, enrolling 88 eligible YLWH that received ART for at least 6 months. Our primary outcome of interest was viral load suppression, defined as a viral load detected of ≤500 copies/mL. Data analysis was performed using Statistical Package for Social Sciences version 20. Fifteen individuals were also purposively selected from the original sample and participated in an in-depth interview that was digitally recorded. Generated transcripts were coded and categories generated manually using the inductive content analytic approach. All participants provided written consent or guardian/parent assent (those <18 years) to participate in the study. RESULTS Forty-nine percent of YLWH were females, the median age was 21 (IQR: 16-22) years. About half of the participants (53%) stayed with a family member. A third (34%) of participants had not disclosed their status to any person they stayed with at home. Only 23% reported getting moderate to high family social support (Median score 2.3; IQR: 1.6-3.2). Seventy-eight percent of YLWH recorded viral load suppression. Viral load suppression was associated with one living with a parent, sibling, or spouse (AOR: 6.45; 95% CI: 1.16-16.13; P = .033), having a primary caretaker with a regular income (AOR: 1.57; 95% CI: 1.09-4.17; P = .014), and living or communicating with family at least twice a week (AOR: 4.2; 95% CI: 1.65-7.14; P = .003). Other significant factors included youth receiving moderate to high family support (AOR: 12.11; 95% CI: 2.06-17.09; P = .006) and those that perceived family support in the last 2 years as helpful (AOR: 1.98; 95% CI: 1.34-3.44; P = .001). HIV stigma (AOR: 0.10; 95% CI: 0.02-0.23; P = .007) and depression (AOR: 0.31; 95% CI: 0.06-0.52; P = .041) decreased viral load suppression. Qualitative data showed that dysfunctional family relationships, economic insecurity, physical separation, HIV- and disclosure-related stigma, past and ongoing family experiences with HIV/ART affected active family support. These factors fueled feelings of abandonment, helplessness, discrimination, and economic or emotional strife among YLWH. CONCLUSION Our data showed that living with a family member, having a primary caretaker with a regular income, living or communicating with family members regularly, and reporting good family support were associated with viral load suppression among YLWH in rural southwestern Uganda. Experiencing depression due to HIV and or disclosure-related stigma was associated with increased viral load. All YLWH desire ongoing emotional, physical, and financial support from immediate family to thrive and take medications daily and timely. Future interventions should explore contextual community approaches that encourage acceptance, disclosure, and resource mobilization for YLWH who rely on family support to use ART appropriately.
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Affiliation(s)
| | | | | | | | | | | | - Celestino Obua
- Mbarara University of Science and TechnologyMbararaUganda
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Ajuna N, Tumusiime B, Amanya J, Awori S, Rukundo GZ, Asiimwe JB. Social Networks and Barriers to ART Adherence Among Young Adults (18-24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:939-958. [PMID: 34675686 PMCID: PMC8504700 DOI: 10.2147/hiv.s328643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022]
Abstract
Background Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18–24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. Methods This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Results Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals’ directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication- (eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Conclusion Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.
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Affiliation(s)
- Noble Ajuna
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Brian Tumusiime
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Joseph Amanya
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Sharon Awori
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara City, Southwestern Uganda
| | - John Baptist Asiimwe
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
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Simms V, Bernays S, Chibanda D, Chinoda S, Mutsinze A, Beji‐Chauke R, Mugurungi O, Apollo T, Sithole D, Verhey R, Weiss HA, Willis N. Risk factors for HIV virological non-suppression among adolescents with common mental disorder symptoms in Zimbabwe: a cross-sectional study. J Int AIDS Soc 2021; 24:e25773. [PMID: 34402199 PMCID: PMC8368838 DOI: 10.1002/jia2.25773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/10/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Adolescents are at increased risk of HIV virological non-suppression compared to adults and younger children. Common mental disorders such as anxiety and depression are a barrier to adherence and virological suppression. The aim of this study was to identify factors associated with virological non-suppression among adolescents living with HIV (ALWH) in Zimbabwe who had symptoms of common mental disorders. METHODS We utilized baseline data from a cluster-randomized controlled trial of a problem-solving therapy intervention to improve mental health and HIV viral suppression of ALWH. Sixty clinics within 10 districts were randomized 1:1 to either the intervention or control arm, with the aim to recruit 14 adolescents aged 10 to 19 per clinic. Adolescents were eligible if they scored ≥7 on the Shona Symptom Questionnaire measuring symptoms of common mental disorders. Multivariable mixed-effects logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with non-suppression, defined as viral load ≥1000 copies/mL. RESULTS Between 2 January and 21 March 2019 the trial enrolled 842 participants aged 10 to 19 years (55.5% female, 58.8% aged <16). Most participants (N = 613) were taking an NNRTI-based ART regimen (13 PI-based, 216 unknown) and median duration on ART was six years (IQR three to nine years, 240 unknown). Of the 833 with viral load data 292 (35.1%) were non-suppressed. Virological non-suppression was independently associated with male sex (adjusted OR (aOR) = 1.43, 95% CI 1.04 to 1.97), and with not knowing one's own HIV status (aOR = 1.77, 95% CI 1.08 to 2.88), or knowing one's status but not disclosing it to anyone (aOR = 1.99, 95% CI 1.36 to 2.93), compared to adolescents who knew their status and had disclosed it to someone. CONCLUSIONS ALWH with symptoms of common mental disorders have high prevalence of virological non-suppression in Zimbabwe, especially if they do not know their status or have not disclosed it. In general adolescents should be informed of their HIV status, with encouragement on the beneficial health and social effects of viral suppression, to incentivise adherence. Efforts to strengthen the operationalization of disclosure guidelines for adolescents should now be prioritized.
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Affiliation(s)
- Victoria Simms
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene & Tropical MedicineLondonUK
| | - Sarah Bernays
- London School of Hygiene & Tropical MedicineLondonUK
| | - Dixon Chibanda
- London School of Hygiene & Tropical MedicineLondonUK
- Friendship BenchHarareZimbabwe
- Department of PsychiatryUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | | | | | | | - Owen Mugurungi
- AIDS & TB UnitMinistry of Health and Child CareHarareZimbabwe
| | - Tsitsi Apollo
- AIDS & TB UnitMinistry of Health and Child CareHarareZimbabwe
| | - Dorcas Sithole
- Mental Health ServicesMinistry of Health and Child CareHarareZimbabwe
| | | | - Helen A Weiss
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene & Tropical MedicineLondonUK
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Tumwine C, Aggleton P, Bell S. Enhancing HIV Prevention: Social Support, Access to, and Use of HIV Testing, Treatment, and Care Services in Fishing Communities Around Lake Victoria, Uganda. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:196-211. [PMID: 32749878 DOI: 10.1521/aeap.2020.32.3.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers to identify experiences of social support and its influence on access to and use of HIV testing, treatment, and care. Fisherfolk participants reported receiving support at some point. Prior to HIV diagnosis, this usually took the form of advice on what illness they were dealing with and remedies to use. After HIV diagnosis and disclosure to friends or family, emotional support enabled fisherfolk to come to terms with an HIV diagnosis, informational support offered guidance on how best to live with HIV, while instrumental support enabled access to relevant HIV services. Finally, affiliative support, in the form of new friends met through HIV clinic visits, provided a sense of belonging. Each of these different kinds of support assisted fisherfolk to respond positively to HIV with important consequences for secondary and tertiary prevention.
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Affiliation(s)
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Australia, The Australian National University, Canberra, and the Centre for Gender and Global Health, University College London, UK
| | - Stephen Bell
- Centre for Social Research in Health and Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
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Amoah PA. The Relationship among Functional Health Literacy, Self-Rated Health, and Social Support among Younger and Older Adults in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173188. [PMID: 31480487 PMCID: PMC6747074 DOI: 10.3390/ijerph16173188] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022]
Abstract
It is well established that health literacy positively affects health outcomes, and social support influences this association. What remains unclear is which aspect of social support (instrumental, informational, and emotional support) is responsible for this effect and whether the influence differs from one population group to another. This study addresses these lacunae. It examines the impact each type of support makes on the relation between functional health literacy (FHL) and self-rated health status among younger and older adults in Ghana. Data were pooled from two cross-sectional surveys, together comprising 521 participants in the Ashanti Region. The results indicated that young adults were more likely to possess sufficient FHL and perceive their health more positively than older adults. While FHL was positively associated with health status, the relation was stronger when young adults received a high level of emotional support. Among older persons, informational support substantially moderated the association between FHL and health status. Thus, social support modifies the relations between FHL and health status among younger and older adults in different ways and to different degrees. Therefore, interventions to improve FHL and health amongst younger and older adults should pay due regard to relevant aspects of social support.
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Affiliation(s)
- Padmore Adusei Amoah
- School of Graduate Studies; Asia Pacific Institute of Ageing Studies; Centre for Social Policy & Social Change, Lingnan University, Hong Kong (SAR).
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