122
views
0
recommends
+1 Recommend
2 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction

          There are two million HIV‐positive adolescents in southern Africa, and this group has low retention in care and high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self‐reported retention. This study examines factors associated with retention amongst antiretroviral therapy ( ART)‐initiated adolescents in South Africa.

          Methods

          We collected clinical records and detailed standardized interviews (n = 1059) with all 10‐ to 19 year‐olds ever initiated on ART in all 53 government clinics of a health subdistrict, and community traced to include lost‐to‐follow‐up (90.1% of eligible adolescents interviewed). Associations between full self‐reported retention in care (no past‐year missed appointments and 85% past‐week adherence) and health service factors were tested simultaneously in sequential multivariate regression and marginal effects modelling, controlling for covariates of age, gender, urban/rural location, formal/informal housing, maternal and paternal orphanhood, vertical/horizontal HIV infection, overall health, length of time on ART and type of healthcare facility.

          Results

          About 56% of adolescents had self‐reported retention in care, validated against lower detectable viral load ( AOR: 0.63, CI: 0.45 to 0.87, p = 0.005). Independent of covariates, five factors ( STACK) were associated with improved retention: clinics Stocked with medication ( OR: 3.0, CI: 1.6 to 5.5); staff with Time for adolescents ( OR: 2.7, CI: 1.8 to 4.1); adolescents Accompanied to the clinic ( OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely ( OR: 1.4, CI: 1.1 to 1.9); and staff who are Kind ( OR: 2.6, CI: 1.8 to 3.6). With none of these factors, 3.3% of adolescents reported retention. With all five factors, 69.5% reported retention.

          Conclusions

          This study identifies key intervention points for adolescent retention in HIV care. A basic package of clinic and community services has the potential to STACK the odds for health and survival for HIV‐positive adolescents.

          Related collections

          Most cited references44

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

          Summary Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8–61·8) and varied widely by country, ranging from 85·5 (84·2–86·5) in Iceland to 20·4 (15·4–24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r 2=0·88) and the MDG index (r 2=0·92), whereas the non-MDG index had a weaker relation with SDI (r 2=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0–10·4), and gains on the MDG index (a median change of 10·0 [6·7–13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1–8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs. Funding Bill & Melinda Gates Foundation.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges.

            Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities. Copyright © 2014 Elsevier Ltd. All rights reserved.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors

              Abstract Introduction: Globally adolescents and young adults account for more than 40% of new HIV infections, and HIV-related deaths amongst adolescents increased by 50% from 2005 to 2012. Adherence to antiretroviral therapy (ART) is critical to control viral replication and preserve health; however, there is a paucity of research on adherence amongst the growing population of adolescents living with HIV/AIDS (ALHIV) in Southern Africa. We examined levels of self-reported ART adherence, barriers to adherence, and factors associated with non-adherence amongst ALHIV in Malawi. Methods: Cross-sectional study of 519 ALHIV (12–18 years) attending two large HIV clinics in central and south-eastern Malawi. Participants self-reported missed doses (past week/month), barriers to adherence, and completed questionnaires on past traumatic events/stressors, disclosure, depression, substance use, treatment self-efficacy, and social support. Biomedical data were retrieved from existing medical records. Multivariate logistic regression was performed to identify factors independently associated with self-reported ART adherence (7 day recall). Results: The mean age of participants (SD) was 14.5 (2) years and 290 (56%) were female. Of the 519 participants, 153 (30%) reported having missed ART doses within the past week, and 234 (45%) in the past month. Commonly reported barriers to adherence included forgetting (39%), travel from home (14%), busy with other things (11%), feeling depressed/overwhelmed (6%), feeling stigmatized by people outside (5%) and within the home (3%). Factors found to be independently associated with missing a dose in the past week were drinking alcohol in the past month (OR 4.96, 95% CI [1.41–17.4]), missed clinic appointment in the past 6 months (OR 2.23, 95% CI [1.43–3.49]), witnessed or experienced violence in the home (OR 1.86, 95% CI [1.08–3.21]), and poor treatment self-efficacy (OR 1.55 95% CI [1.02–2.34]). Sex and age were not associated with adherence. Conclusions: In our study, nearly half of all ALHIV reported non-adherence to ART in the past month. Violence in the home or alcohol use in the past year as well as poor treatment self-efficacy were associated with worse adherence. Sub-optimal adherence is a major issue for ALHIV and compromise treatment outcomes. Programmes specifically tailored to address those challenges most pertinent to ALHIV may help improve adherence to ART.
                Bookmark

                Author and article information

                Contributors
                lucie.cluver@spi.ox.ac.uk
                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                10.1002/(ISSN)1758-2652
                JIA2
                Journal of the International AIDS Society
                John Wiley and Sons Inc. (Hoboken )
                1758-2652
                21 September 2018
                September 2018
                : 21
                : 9 ( doiID: 10.1002/jia2.2018.21.issue-9 )
                : e25176
                Affiliations
                [ 1 ] Department of Social Policy and Intervention University of Oxford Oxford United Kingdom
                [ 2 ] Department of Psychiatry and Mental Health University of Cape Town Cape Town South Africa
                [ 3 ] Secretariat International HIV/AIDS Alliance Brighton United Kingdom
                [ 4 ] AIDS and Society Research Unit University of Cape Town Cape Town South Africa
                [ 5 ] Department of Sociology University of Cape Town Cape Town South Africa
                [ 6 ] MRC/Wits Developmental Pathways for Health Research Unit School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
                [ 7 ] School of Public Health University of the Western Cape Cape Town South Africa
                [ 8 ] Department of Nursing Fort Hare University Alice South Africa
                [ 9 ] Research Department of Global Health University College London London United Kingdom
                Author notes
                [*] [* ] Corresponding author: Lucie Cluver, Department of Social Policy and Intervention, Center for Evidence‐Based Intervention, University of Oxford, Oxford, OX1 2ER, United Kingdom. Tel: +44 (0)1865 270325. ( lucie.cluver@ 123456spi.ox.ac.uk )
                Author information
                http://orcid.org/0000-0002-0418-835X
                http://orcid.org/0000-0002-7239-645X
                http://orcid.org/0000-0002-3800-3173
                http://orcid.org/0000-0001-9951-6733
                Article
                JIA225176
                10.1002/jia2.25176
                6149366
                30240121
                0e424d81-ea6c-46cf-bcc2-f378db0199c2
                © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 February 2018
                : 13 July 2018
                Page count
                Figures: 1, Tables: 5, Pages: 8, Words: 7767
                Funding
                Funded by: HIV Prevention in Southern Africa (EHPSA)
                Funded by: Janssen Pharmaceutica N.V. & Janssen Pharmaceutica (PTY) LTS South Africa
                Funded by: Janssen Pharmaceutical Companies of Johnson & Johnson
                Funded by: CIPHER
                Award ID: 155‐Hod
                Funded by: Claude Leon Foundation
                Award ID: F08 559/C
                Funded by: Oak Foundation
                Award ID: R46194/AA001
                Funded by: UNICEF Eastern and Southern Africa
                Funded by: John Fell Fund
                Award ID: 103/757 &
                Award ID: 161/033
                Funded by: Oxford University Clarendon‐Green Templeton College Scholarship
                Funded by: European Union's Seventh Framework Programme
                Award ID: FP7/2007‐2013
                Funded by: ERC
                Award ID: n°313421
                Funded by: Philip Leverhulme Trust
                Award ID: PLP‐2014‐095
                Funded by: University of Oxford's ESRC Impact Acceleration Account
                Award ID: IAA‐MT13‐003
                Award ID: K1311‐KEA‐004
                Award ID: 1602‐KEA‐189
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                jia225176
                September 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.9 mode:remove_FC converted:21.09.2018

                Infectious disease & Microbiology
                adolescent,hiv,delivery of healthcare,medication therapy management,adolescent health services,viral load

                Comments

                Comment on this article