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Nabunya P, Kizito S, Naseh M, Raymond A, Ssentumbwe V. Preliminary Impact of Group-Based Interventions on Stigma and the Mental Health of Caregivers of Adolescents Living with HIV in Uganda. AIDS Behav 2024; 28:2769-2779. [PMID: 38683434 PMCID: PMC11286362 DOI: 10.1007/s10461-024-04353-8] [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: 04/18/2024] [Indexed: 05/01/2024]
Abstract
This study examined the preliminary impact of group-cognitive behavioral therapy (G-CBT) and a family-strengthening intervention delivered via multiple family groups (MFG-FS) on HIV stigma, parenting stress, and the mental health of caregivers of adolescents living with HIV. We analyzed data from the Suubi4Stigma study (2020-2022), a two-year pilot randomized clinical trial for adolescents and their caregivers (N = 89 dyads), recruited from nine health clinics in Uganda. Adolescent-caregiver dyads were randomized to three intervention conditions delivered over three months, with data collected at baseline, three and six-months follow-up. We fitted mixed-effects linear regression models to test the effect of the interventions on caregiver outcomes over time. At six months, caregivers randomized to the MFG-FS condition reported lower levels of stigma by association (mean difference = -1.45, 95% CI = -2.52 - -0.38, p = 0.008), and stigma and discrimination attitudes (mean difference = -3.84, 95% CI = -4.63 - -3.05, p < 0.001), compared to Usual care condition. In addition, caregivers of adolescents randomized to the G-CBT condition reported lower levels of stigma and discrimination attitudes at three months (mean difference = -5.18, 95% CI = -9.13 - -1.22, p = 0.010), and at six months (mean difference = -6.70, 95% CI = -9.28 - -4.12, p < 0.001). Caregiver mental health and parenting stress significantly reduced over time regardless of intervention condition. Findings point to the importance of incorporating stigma reduction components within psychosocial interventions targeting adolescents and families impacted by HIV.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Mitra Naseh
- The Initiative on Social Work & Forced Migration, Brown School, Washington University in St. Louis, St. Louis, USA
| | - Atwebembere Raymond
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
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Nabunya P, Migadde H, Namuwonge F, Mugisha J, Kirabo W, Ssentumbwe V, Claire N, Raymond A, Bahar OS, Mwebembezi A, McKay MM, Ssewamala FM. Feasibility and Acceptability of Group-Based Stigma Reduction Interventions for Adolescents Living with HIV and Their Caregivers: The Suubi4Stigma Randomized Clinical Trial (2020-2022). AIDS Behav 2024; 28:1630-1641. [PMID: 38308772 PMCID: PMC11070307 DOI: 10.1007/s10461-024-04284-4] [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: 01/26/2024] [Indexed: 02/05/2024]
Abstract
This study examined the feasibility and acceptability of two group-based interventions: group-cognitive behavioral therapy (G-CBT) and a family-strengthening intervention delivered via multiple family group (MFG-FS), to address HIV stigma among adolescents living with HIV (ALHIV) and their caregivers. A total of 147 adolescent -caregiver dyads from 9 health clinics situated within 7 political districts in Uganda were screened for eligibility. Of these, 89 dyads met the inclusion criteria and provided consent to participate in the study. Participants were randomized, at the clinic level, to one of three study conditions: Usual care, G-CBT or MFG-FS. The interventions were delivered over a 3-month period. While both adolescents and their caregivers attended the MFG-FS sessions, G-CBT sessions were only attended by adolescents. Data were collected at baseline, 3 and 6-months post intervention initiation. The retention rate was 94% over the study period. Across groups, intervention session attendance ranged between 85 and 92%, for all sessions. Fidelity of the intervention was between 85 and 100%, and both children and caregivers rated highly their satisfaction with the intervention sessions. ALHIV in Uganda, and most of sub-Saharan Africa, are still underrepresented in stigma reduction interventions. The Suubi4Stigma study was feasible and acceptable to adolescents and their caregivers -supporting testing the efficacy of the interventions in a larger trial.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA.
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Kirabo
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Najjuuko Claire
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, USA
| | - Atwebembere Raymond
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | | | - Mary M McKay
- Office of the Vice Provost, Washington University in St. Louis, St. Louis, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
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Yiryuo L, Osman W, Kpekura S. A phenomenological study of the beliefs of family caregivers of children living with HIV/AIDS on adherence to antiretroviral therapy. Nurs Open 2023; 10:6117-6124. [PMID: 37209366 PMCID: PMC10416031 DOI: 10.1002/nop2.1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/01/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023] Open
Abstract
AIM To explore the beliefs of family caregivers on adherence to Anti-Retroviral Therapy (ART) among children living with HIV/AIDS that received care at St. Joseph's Hospital, Jirapa, Ghana. DESIGN A qualitative phenomenological design was employed for this study. METHOD Data was gathered using a semi-structured in-depth interview guide from 13 family caregivers of children with HIV/AIDS on ART. Analysis was done using the reflexive thematic analysis approach. RESULTS Three major themes were generated during the analysis: "Beliefs regarding the effectiveness of ART"; "Beliefs regarding taking ART"; and "Beliefs regarding other treatments for HIV/AIDS". Most caregivers believed that the ARTs were effective and improved their children's health, especially when adhered to strictly. Some, however, believed in praying to God for healing, and the use of local/herbal to augment ARTs. CONCLUSION Family caregivers generally hold positive beliefs about ARTs and its effectiveness for their children. Some, however, believe in spirits, prayers, and herbal/local treatment in addition to ARTs.
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Affiliation(s)
- Lilian Yiryuo
- St. Joseph's HospitalGhana Health ServiceJirapaGhana
- Faculty of Paediatric NursingGhana College of Nurses and Midwives (GCNM)AccraGhana
| | - Wahab Osman
- Faculty of Paediatric NursingGhana College of Nurses and Midwives (GCNM)AccraGhana
- Department of Advanced Nursing Practice, School of Nursing and MidwiferyUniversity for Development StudiesTamaleGhana
| | - Stephen Kpekura
- School of Nursing and MidwiferyC.K. Tedam University of Technology and Applied SciencesNavrongoGhana
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Hayati H, Nurhaeni N, Wanda D, Nuraidah. Understanding the experiences of caregivers of HIV-exposed children under five: A phenomenological inquiry. BELITUNG NURSING JOURNAL 2023; 9:152-158. [PMID: 37469580 PMCID: PMC10353593 DOI: 10.33546/bnj.2479] [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: 12/08/2022] [Revised: 01/05/2023] [Accepted: 03/04/2023] [Indexed: 07/21/2023] Open
Abstract
Background Children born to mothers with HIV require special care from the womb to the postnatal period, and caregivers involved in their care face several challenges. Objective This study aimed to explore caregivers' experiences providing care for HIV-exposed children under five. Methods This study employed a phenomenological approach. Ten caregivers of HIV-exposed children living in Jakarta, Indonesia, were selected using snowball techniques. Online in-depth interviews were conducted to collect data from September 2021 to July 2022, and thematic analysis using Colaizzi's method was performed for data analysis. Results The study involved ten caregivers (nine females and one male) aged between 23 and 42 years. Seven of them were mothers who tested HIV-positive, while one was an adoptive father, one was a mother's sister, and one was an aunt of HIV-exposed children. The majority of them were housewives and had a low educational background. Three themes were generated: (i) disease-transmission foreboding, (ii) prejudice against mothers and children exposed to HIV, and (iii) seeking support. Conclusion Caring for HIV-exposed children poses emotional and physical challenges for caregivers, necessitating support from health professionals and peer groups. Nurses play essential roles in improving caregiver well-being and supporting optimal growth and development in HIV-exposed children under five by designing intervention programs. Furthermore, to enhance home-based HIV care in Indonesia, the government must implement social interventions that target families with limited resources.
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Affiliation(s)
- Happy Hayati
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Nani Nurhaeni
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Dessie Wanda
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Nuraidah
- Rumah Sakit Penyakit Infeksi Sulianti Saroso, DKI Jakarta, Indonesia
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Atanuriba GA, Apiribu F, Boamah Mensah AB, Dzomeku VM, Afaya RA, Gazari T, Kuunibe JK, Amooba PA. Caregivers' Experiences with Caring for a Child Living with HIV/AIDS: A Qualitative Study in Northern Ghana. Glob Pediatr Health 2021; 8:2333794X211003622. [PMID: 33816712 PMCID: PMC7995303 DOI: 10.1177/2333794x211003622] [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: 02/19/2021] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
With the advent of Anti-Retroviral Therapy, Human Immune Virus, and Acquire Immuno-Deficiency Syndrome is increasingly becoming a chronic disease as life expectancy among People Living With HIV/AIDS has increased. For Children Living With HIV/AIDS the role of the caregivers becomes essential as caregivers' decisions affect CLWH health. However, the experiences of these caregivers are often unnoticed while all interventions are directed at PLWH. This study aimed at exploring the experiences of caregivers of CLWH in some selected hospitals in northern Ghana. This study employed a qualitative descriptive phenomenological approach. Purposive sampling technique was used to recruit 9 participants from 3 public hospitals in the Tamale Metropolis of Ghana. Data was manually analyzed using the approach of Collaizi and the findings were presented in themes and sub-themes. We conducted individual face to face interviews in English and Dagbani from September to November 2019. These interviews were conducted at the convenience of the participants in hospitals and at their homes. They were introduced to the study while awaiting to take antivirals for their CLWH. Five themes emerged: changed family dynamics, discovery of diagnosis, reaction to diagnosis, disclosure, stigma and discrimination, and burden and challenges of care. Caregivers were severely impacted by caring for CLWH and traumatized by changed family dynamics which exposed them to many difficulties. Stigma was widely perpetrated by immediate family members and majority reacted badly to their children HIV-positive status with fear, shame, guilt and even suicidal ideation.
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Affiliation(s)
| | - Felix Apiribu
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Richard Adongo Afaya
- University for Development Studies, School of Nursing and Midwifery, Tamale, Ghana
| | - Timothy Gazari
- University for Development Studies, School of Nursing and Midwifery, Tamale, Ghana
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Buthelezi SF, Modeste RRM, Phetlhu DR. Barriers to the management of children under five exposed to HIV in the rural areas of South Africa. Curationis 2021; 44:e1-e12. [PMID: 33764130 PMCID: PMC8008009 DOI: 10.4102/curationis.v44i1.2073] [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: 04/19/2019] [Revised: 11/17/2019] [Accepted: 12/07/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND South Africa has made enormous progress in reducing mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), however, MTCT and AIDS related death persist among children particularly in the rural areas. Lack of adherence to health policies and guidelines implementation remain one of the contributory factors to poor management of HIV-exposed children. Hence, the need to deeply explore the complexity of the problems and understand the barriers to the management of HIV exposed children in the rural areas. OBJECTIVES To explore and synthesise the barriers to the management of children under 5 years old exposed to HIV in rural areas in South Africa. METHOD An integrative literature review was conducted. An electronic search was conducted on several databases. The researchers applied the Boolean ' AND'/'OR' in combination with phrases such as 'HIV infection*', 'HIV transmission', 'HIV-exposed infant*, child*, and neonate*' and 'South Africa*'. Included studies were limited to South Africa, and articles were written in English and published in peer-reviewed journals from 2005 to 2018. Both qualitative and quantitative studies between 2005 and 2018 were utilised. RESULTS The findings highlighted that healthcare institution-related barriers, healthcare provider-related barriers, patient-related barriers and Socio-economic-related barriers were the significant barriers to the management of HIV-exposed children in the rural areas. CONCLUSION Continuous engagement with all relevant stakeholders should remain a priority in protecting HIV-exposed children. It is evident that there exist gaps in the current implementation of prevention of mother-to-child transmission (PMTCT), especially in rural areas. Therefore, intervention strategies that could improve implementation of PMTCT policy guidelines for HIV-exposed children in rural areas are needed.
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Pillay Y. Towards an AIDS-free generation by 2030: how are South African children, adolescents, caregivers and health care workers coping with HIV? SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/0081246321992175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We are committed to an AIDS free generation by 2030 – nine short years away. This article reflects on the global and South African data on new infections, total number of children and adolescents living with HIV as well as data on vertical transmission. The article includes the voices of key stakeholders in the quest to end HIV in children so that lessons from their experiences can be used by policy makers in strengthening services.
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Affiliation(s)
- Yogan Pillay
- Clinton Health Access Initiative (CHAI), South Africa
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Maddocks S, Chetty V. Burden of caring for children living with human immunodeficiency virus in a semi-rural South African community. S Afr Fam Pract (2004) 2020; 62:e1-e5. [PMID: 32633994 PMCID: PMC8377773 DOI: 10.4102/safp.v62i1.5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Stacy Maddocks
- Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Campbell L, Masquillier C, Thunnissen E, Ariyo E, Tabana H, Sematlane N, Delport A, Dube LT, Knight L, Kasztan Flechner T, Wouters E. Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review . INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3808. [PMID: 32471153 PMCID: PMC7312869 DOI: 10.3390/ijerph17113808] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 01/12/2023]
Abstract
Adherence to HIV antiretroviral therapy (ART) is a crucial factor in health outcomes for people living with HIV (PLWH). Interventions to support ART adherence are increasingly focused on the household as a source of social support. This review aims to examine the social and structural determinants of support for ART adherence within households and families in low- and middle-income countries (LMICs). The review methodology followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven databases were searched for peer-reviewed literature. The terms searched thematically covered (1) ART adherence, (2) household and family and (3) support and care. Thirty-three studies conducted in 15 LMICs were selected and a mixed methods synthesis was undertaken. Social and structural determinants affected the type, quality and amount of support for PLWH of all ages, which affected PLWH's ART adherence. Gender norms affected the type of support that household members give to PLWH. Education moderated household support for ART adherence through literacy and language skills. Cultural context, religious beliefs, and social norms reinforced or undermined household support for ART adherence. Stigma affected disclosure, generated secrecy around giving medication and impeded access to support from the community. Supporting PLWH exacerbated economic hardship for household members. Health system dysfunction negatively impacted trust and communication between household members and health professionals. Intersecting social and structural determinants particularly affected the care given by household members who were older, female, with little education and low socioeconomic status. Household members were able to overcome some of these barriers when they received support themselves. Household interventions to support PLWH's ART adherence should take structural factors into account to have maximum impact.
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Affiliation(s)
- Linda Campbell
- Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium; (C.M.); (E.T.); (E.A.); (T.K.F.); (E.W.)
| | - Caroline Masquillier
- Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium; (C.M.); (E.T.); (E.A.); (T.K.F.); (E.W.)
| | - Estrelle Thunnissen
- Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium; (C.M.); (E.T.); (E.A.); (T.K.F.); (E.W.)
| | - Esther Ariyo
- Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium; (C.M.); (E.T.); (E.A.); (T.K.F.); (E.W.)
| | - Hanani Tabana
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (H.T.); (N.S.); (A.D.); (L.T.D.); (L.K.)
| | - Neo Sematlane
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (H.T.); (N.S.); (A.D.); (L.T.D.); (L.K.)
| | - Anton Delport
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (H.T.); (N.S.); (A.D.); (L.T.D.); (L.K.)
| | - Lorraine Tanyaradzwa Dube
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (H.T.); (N.S.); (A.D.); (L.T.D.); (L.K.)
| | - Lucia Knight
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (H.T.); (N.S.); (A.D.); (L.T.D.); (L.K.)
| | - Tair Kasztan Flechner
- Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium; (C.M.); (E.T.); (E.A.); (T.K.F.); (E.W.)
| | - Edwin Wouters
- Centre for Population, Family and Health, University of Antwerp, 2000 Antwerp, Belgium; (C.M.); (E.T.); (E.A.); (T.K.F.); (E.W.)
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Buthelezi SF, Modeste RR, Phetlhu DR. Barriers to the management of children under five exposed to human immunodeficiency virus in the rural areas in South Africa. Curationis 2020. [DOI: 10.4102/curationis.v43i1.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Buthelezi SF, Marie Modeste RR, Phetlhu DR. Impediments and reasons for poor management of children under five exposed to HIV in South Africa. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2019.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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van den Heuvel LL, Levin J, Mpango RS, Gadow KD, Patel V, Nachega JB, Seedat S, Kinyanda E. Agreement and Discrepancy on Emotional and Behavioral Problems Between Caregivers and HIV-Infected Children and Adolescents From Uganda. Front Psychiatry 2019; 10:460. [PMID: 31354539 PMCID: PMC6637279 DOI: 10.3389/fpsyt.2019.00460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/11/2019] [Indexed: 01/14/2023] Open
Abstract
Background: HIV-infected children and adolescents (CA-HIV) face significant mental health challenges related to a broad range of biological and psychosocial factors. Data are scarce on the agreement and discrepancy between caregivers and CA-HIV regarding emotional and behavioral problems (EBPs) in CA-HIV. Objectives: We determined agreement between self- versus caregiver- reported EBPs and describe factors associated with informant discrepancy among caregiver-youth dyads who participated in the "Mental health among HIV-infected CHildren and Adolescents in KAmpala and Masaka, Uganda" (CHAKA) study. Methods: In a cross-sectional sample, caregiver-reported EBPs were assessed with the Child and Adolescent Symptom Inventory-5 (CASI-5), and self-reported problems were evaluated with the Youth Inventory-4 (YI-4) in 469 adolescents aged 12-17 years and the Child Inventory-4 (CI-4) in 493 children aged 8-11 years. Adolescents were questioned about experiences of HIV stigma. Caregiver psychological distress was assessed with the Self-Reporting Questionnaire (SRQ-20). Linear regression models were applied to identify variables associated with discrepancy scores. Results: Self-reported emotional problems (EPs) were present in 28.8% of adolescents and 36.9% of children, and 14.5% of adolescents self-reported behavioral problems (BPs). There was only a modest correlation (r ≤ 0.29) between caregiver- and CA-HIV-reported EBPs, with caregivers reporting more EPs whereas adolescents reported more BPs. Informant discrepancy between adolescents and caregivers for BPs was associated with adolescent age and caregiver's employment and HIV status. Among adolescents, EP discrepancy scores were associated with adolescent's WHO HIV clinical stage, caregiver level of education, and caregivers caring for other children. Among children, EP discrepancy scores were associated with child and caregiver age, caregiver level of education, and caregiver self-rated health status. HIV stigma and caregiver psychological distress were also associated with discrepancy, such that adolescents who experienced HIV stigma rated their EPs as more severe than their caregivers did and caregivers with increased psychological distress rated EBPs as more severe than CA-HIV self-rated. Conclusions: EBPs are frequently endorsed by CA-HIV, and agreement between informants is modest. Informant discrepancy is related to unique psychosocial and HIV-related factors. Multi-informant reports enhance the evaluation of CA-HIV and informant discrepancies can provide additional insights into the mental health of CA-HIV.
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Affiliation(s)
- Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard S Mpango
- Mental Health Project, MRC/UVRI Uganda Research Unit on AIDS/Senior Wellcome Trust Fellowship, Entebbe, Uganda
| | - Kenneth D Gadow
- Department of Psychiatry, Stony Brook University, New York, NY, United States
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, MA, United States
| | - Jean B Nachega
- Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States.,Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Eugene Kinyanda
- Mental Health Project, MRC/UVRI Uganda Research Unit on AIDS/Senior Wellcome Trust Fellowship, Entebbe, Uganda.,Department of Psychiatry, Makerere College of Health Sciences, Kampala, Uganda.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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