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

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          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.

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          Most cited references32

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          Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study.

          In this study, 306 individuals in 3 age groups--adolescents (13-16), youths (18-22), and adults (24 and older)--completed 2 questionnaire measures assessing risk preference and risky decision making, and 1 behavioral task measuring risk taking. Participants in each age group were randomly assigned to complete the measures either alone or with 2 same-aged peers. Analyses indicated that (a) risk taking and risky decision making decreased with age; (b) participants took more risks, focused more on the benefits than the costs of risky behavior, and made riskier decisions when in peer groups than alone; and (c) peer effects on risk taking and risky decision making were stronger among adolescents and youths than adults. These findings support the idea that adolescents are more inclined toward risky behavior and risky decision making than are adults and that peer influence plays an important role in explaining risky behavior during adolescence.
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            Adolescent alcohol use: risks and consequences.

            The aim of the study was to summarize results of recent epidemiological research on adolescent alcohol use and its consequences, to outline the risk factors for drinking in adolescents and to consider effective treatment and preventative interventions.
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              Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

              Background There is a recognized gap in the evidence base relating to the nature and components of interventions to address the psycho-social needs of HIV positive young people. We used mixed methods research to strengthen a community support group intervention for HIV positive young people based in Harare, Zimbabwe. Methods A quantitative questionnaire was administered to HIV positive Africaid support group attendees. Afterwards, qualitative data were collected from young people aged 15–18 through tape-recorded in-depth interviews (n = 10), 3 focus group discussions (FGDs) and 16 life history narratives. Data were also collected from caregivers, health care workers, and community members through FGDs (n = 6 groups) and in-depth interviews (n = 12). Quantitative data were processed and analysed using STATA 10. Qualitative data were analysed using thematic analysis. Results 229/310 young people completed the quantitative questionnaire (74% participation). Median age was 14 (range 6–18 years); 59% were female. Self-reported adherence to antiretrovirals was sub-optimal. Psychological well being was poor (median score on Shona Symptom Questionnaire 9/14); 63% were at risk of depression. Qualitative findings suggested that challenges faced by positive children include verbal abuse, stigma, and discrimination. While data showed that support group attendance is helpful, young people stressed that life outside the confines of the group was more challenging. Caregivers felt ill-equipped to support the children in their care. These data, combined with a previously validated conceptual framework for family-centred interventions, were used to guide the development of the existing programme of adolescent support groups into a more comprehensive evidence-based psychosocial support programme encompassing caregiver and household members. Conclusions This study allowed us to describe the lived experiences of HIV positive young people and their caregivers in Zimbabwe. The findings contributed to the enhancement of Africaid’s existing programme of support to better promote psychological well being and ART adherence.
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                Author and article information

                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                ZIAS
                zias20
                Journal of the International AIDS Society
                Taylor & Francis
                1758-2652
                2017
                30 March 2017
                : 20
                : 1
                : 21437
                Affiliations
                [ a ] Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children’s Hospital , Houston, TX, USA
                [ b ] Baylor College of Medicine- Abbott Fund Children’s Clinical Centre of Excellence , Lilongwe, Malawi
                [ c ] Department of Medicine, Baylor College of Medicine , Houston, TX, USA
                [ d ] Design and Analysis Core, Baylor-UT Houston Center for AIDS Research , Houston, TX, USA
                [ e ] ICAP, Mailman School of Public Health and College of Physicians & Surgeons, Columbia University , New York, NY, USA
                Author notes
                [ § ]Corresponding author: Maria H Kim, Baylor College of Medicine Children’s Foundation Centre of Excellence – Malawi , Private Bag B-397, Lilongwe 3, Malawi. Tel: +265 1 750 877. Mobile: +265 998 896 090. ( mhkim@ 123456bcm.edu )
                Article
                1307661
                10.7448/IAS.20.1.21437
                5515061
                28406275
                b6425570-4d9e-40b4-a889-3b140162705b
                © 2017 Kim MH et al; licensee International AIDS Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 August 2016
                : 14 March 2017
                Page count
                Tables: 4, References: 55, Pages: 13
                Funding
                Funded by: Texas Children’s Global Health Stimulus Grant and USAID 10.13039/100000200
                Award ID: 674-A-00-10-00093-00
                Funded by: NIH 10.13039/100000002
                Award ID: P30-AI36211
                Funded by: Fogarty International Center of the National Institutes of Health 10.13039/100000061
                Award ID: K01 TW009644
                This study was made possible by support from the Texas Children’s Global Health Stimulus Grant and USAID cooperative agreement number 674-A-00-10-00093-00. MHK was supported by the Fogarty International Center of the National Institutes of Health under award number K01 TW009644. Data analysis was provided by the Design and Analysis Core of the Baylor-UT Houston Center for AIDS Research, an NIH funded program numbered P30-AI36211.
                Categories
                Other
                Research Article

                Infectious disease & Microbiology
                antiretroviral therapy,hiv,adherence,adolescents,sub-saharan africa,alcohol,violence,self-efficacy

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