Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?

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

Low ART-adherence amongst adolescents is associated with morbidity, mortality and onward HIV transmission. Reviews find no effective adolescent adherence-promoting interventions. Social protection has demonstrated benefits for adolescents, and could potentially improve ART-adherence. This study examines associations of 10 social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10–19-year-olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa’s Eastern Cape were traced and interviewed in 2014–2015 ( n = 1175 eligible). About 90% of the eligible sample was included ( n = 1059). Social protection provisions were “cash/cash in kind”: government cash transfers, food security, school fees/materials, school feeding, clothing; and “care”: HIV support group, sports groups, choir/art groups, positive parenting and parental supervision/monitoring. Analyses used multivariate regression, interaction and marginal effects models in SPSS and STATA, controlling for socio-demographic, HIV and healthcare-related covariates. Findings showed 36% self-reported past-week ART non-adherence (<95%). Non-adherence was associated with increased opportunistic infections ( p = .005, B .269, SD .09), and increased likelihood of detectable viral load at last test (>75 copies/ml) (aOR 1.98, CI 1.1–3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR .57, CI .42–.76, p < .001); HIV support group attendance (aOR .60, CI .40–.91, p < .02), and high parental/caregiver supervision (aOR .56, CI .43–.73, p < .001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection 39–41%, with any two social protections, 27–28% and with all three social protections, 18%. These results demonstrate that social protection provisions, particularly combinations of “cash plus care”, may improve adolescent adherence. Through this they have potential to improve survival and wellbeing, to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents.

Related collections

Most cited references 55

Record: found
Abstract: found
Article: not found

Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial.

Sarah Baird, Richard S Garfein, Craig T McIntosh … (2012)

Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women. We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women. In this cluster randomised trial, never-married women aged 13-22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and randomly assigned with computer-generated random numbers by enumeration area (1:1) to receive cash payments (intervention group) or nothing (control group). Intervention enumeration areas were further randomly assigned with computer-generated random numbers to conditional (school attendance required to receive payment) and unconditional (no requirements to receive payment) groups. Participants in both intervention groups were randomly assigned by a lottery to receive monthly payments ranging from US$1 to $5, while their parents were independently assigned with computer-generated random numbers to receive $4-10. Behavioural risk assessments were done at baseline and 12 months; serology was tested at 18 months. Participants were not masked to treatment status but counsellors doing the serologic testing were. The primary outcomes were prevalence of HIV and herpes simplex virus 2 (HSV-2) at 18 months and were assessed by intention-to-treat analyses. The trial is registered, number NCT01333826. 88 enumeration areas were assigned to receive the intervention and 88 as controls. For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data, weighted HIV prevalence at 18 month follow-up was 1·2% (seven of 490 participants) in the combined intervention group versus 3·0% (17 of 799 participants) in the control group (adjusted odds ratio [OR] 0·36, 95% CI 0·14-0·91); weighted HSV-2 prevalence was 0·7% (five of 488 participants) versus 3·0% (27 of 796 participants; adjusted OR 0·24, 0·09-0·65). In the intervention group, we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence (3/235 [1%] vs 4/255 [2%]) or weighted HSV-2 prevalence (4/233 [1%] vs 1/255 [<1%]). For individuals who had already dropped out of school at baseline, we detected no significant difference between intervention and control groups for weighted HIV prevalence (23/210 [10%] vs 17/207 [8%]) or weighted HSV-2 prevalence (17/211 [8%] vs 17/208 [8%]). Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income settings. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies. Global Development Network, Bill & Melinda Gates Foundation, National Bureau of Economic Research Africa Project, World Bank's Research Support Budget, and several World Bank trust funds (Gender Action Plan, Knowledge for Change Program, and Spanish Impact Evaluation fund). Copyright © 2012 Elsevier Ltd. All rights reserved.

0 comments Cited 230 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa.

Jean Nachega, Michael Hislop, Hoang Nguyen … (2009)

To determine adherence to and effectiveness of antiretroviral therapy (ART) in adolescents vs. adults in southern Africa. Observational cohort study. Aid for AIDS, a private sector disease management program in southern Africa. Adolescents (age 11-19 years; n = 154) and adults (n = 7622) initiating ART between 1999 and 2006 and having a viral load measurement within 1 year after ART initiation. Primary: virologic suppression (HIV viral load < or = 400 copies/mL), viral rebound, and CD4 T-cell count at 6, 12, 18, and 24 months after ART initiation. Secondary: adherence assessed by pharmacy refills at 6, 12, and 24 months. Multivariate analyses: loglinear regression and Cox proportional hazards. A significantly smaller proportion of adolescents achieved 100% adherence at each time point (adolescents: 20.7% at 6 months, 14.3% at 12 months, and 6.6% at 24 months; adults: 40.5%, 27.9%, and 20.6% at each time point, respectively; P < 0.01). Patients achieving 100% 12-month adherence were significantly more likely to exhibit virologic suppression at 12 months, regardless of age. However, adolescents achieving virologic suppression had significantly shorter time to viral rebound (adjusted hazard ratio 2.03; 95% confidence interval: 1.31 to 3.13; P < 0.003). Adolescents were less likely to experience long-term immunologic recovery despite initial CD4 T-cell counts comparable to adults. Compared with adults, adolescents in southern Africa are less adherent to ART and have lower rates of virologic suppression and immunologic recovery and a higher rate of virologic rebound after initial suppression. Studies must determine specific barriers to adherence in this population and develop appropriate interventions.

0 comments Cited 195 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.

David L. Paterson, Susan Swindells, Jeffrey T. Mohr … (2000)

Combination antiretroviral therapy with protease inhibitors has transformed HIV infection from a terminal condition into one that is manageable. However, the complexity of regimens makes adherence to therapy difficult. To assess the effects of different levels of adherence to therapy on virologic, immunologic, and clinical outcome; to determine modifiable conditions associated with suboptimal adherence; and to determine how well clinicians predict patient adherence. Prospective, observational study. HIV clinics in a Veterans Affairs medical center and a university medical center. 99 HIV-infected patients who were prescribed a protease inhibitor and who neither used a medication organizer nor received their medications in an observed setting (such as a jail or nursing home). Adherence was measured by using a microelectronic monitoring system. The adherence rate was calculated as the number of doses taken divided by the number prescribed. Patients were followed for a median of 6 months (range, 3 to 15 months). During the study period, 45,397 doses of protease inhibitor were monitored in 81 evaluable patients. Adherence was significantly associated with successful virologic outcome (P < 0.001) and increase in CD4 lymphocyte count (P = 0.006). Virologic failure was documented in 22% of patients with adherence of 95% or greater, 61% of those with 80% to 94.9% adherence, and 80% of those with less than 80% adherence. Patients with adherence of 95% or greater had fewer days in the hospital (2.6 days per 1000 days of follow-up) than those with less than 95% adherence (12.9 days per 1000 days of follow-up; P = 0.001). No opportunistic infections or deaths occurred in patients with 95% or greater adherence. Active psychiatric illness was an independent risk factor for adherence less than 95% (P = 0.04). Physicians predicted adherence incorrectly for 41% of patients, and clinic nurses predicted it incorrectly for 30% of patients. Adherence to protease inhibitor therapy of 95% or greater optimized virologic outcome for patients with HIV infection. Diagnosis and treatment of psychiatric illness should be further investigated as a means to improve adherence to therapy.

0 comments Cited 175 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): AIDS Care

Journal ID (iso-abbrev): AIDS Care

Journal ID (archive): CAIC

Journal ID (publisher-id): caic20

Title: AIDS Care

Publisher: Taylor & Francis

ISSN (Print): 0954-0121

ISSN (Electronic): 1360-0451

Publication date (Print): 26 May 2016

Publication date (Electronic): 8 July 2016

Volume: 28

Issue: sup2 , Equity Supplement (sponsored by the Coalition for Children Affected by AIDS)

Pages: 73-82

Affiliations

[ ^a ]Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford , Oxford, UK

[ ^b ]Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa

[ ^c ]AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town , Cape Town, South Africa

[ ^d ]DPHRU, School of Clinical Medicine, and DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand , Johannesburg, South Africa

[ ^e ]Health Psychology Unit, Research Department of Infection & Population Health, University College London , London, UK

Author notes

[CONTACT ] L. D. Cluver lucie.cluver@ 123456spi.ox.ac.uk Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford , Oxford OX1 2ER, UK

Article

Publisher ID: 1179008

DOI: 10.1080/09540121.2016.1179008

PMC ID: 4991216

PubMed ID: 27392002

SO-VID: b76c3a68-a36a-488e-8587-cfda81fb644c

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 15 March 2016

Date accepted : 23 March 2016

Page count

Figures: 1, Tables: 4, Equations: 0, References: 48, Pages: 10

Funding

Funded by: European Union’s Seventh Framework Program

Award ID: FP7/2007-2013

Funded by: ERC

Award ID: 313421

Funded by: Philip Leverhulme Trust

Award ID: PLP-2014-095

Funded by: Janssen Educational Grant Programme, and Evidence for HIV Prevention in Southern Africa

Award ID: MM/EHPSA/UCT/05150014

Funded by: European Union’s Seventh Framework Program

Award ID: FP7/2007-2013

This study was funded by the Nuffield Foundation [CPF/41513], the John Fell Fund, CIPHER (155-Hod), Janssen Educational Grant Programme, and Evidence for HIV Prevention in Southern Africa [MM/EHPSA/UCT/05150014]. Analyses and writing were supported by UNICEF. Support was provided to LC by European Research Council (ERC) under the European Union’s Seventh Framework Program [FP7/2007-2013]/ERC grant agreement n° 313421 and the Philip Leverhulme Trust [PLP-2014-095].

Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?

Read this article at

ABSTRACT

Related collections

UCL: UN SDG 05 Gender Equality

Most cited references 55

Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial.

Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa.

Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.

Author and article information

Journal

Affiliations

Author notes

Article

History

Page count

Funding

Categories

Comments

Comment on this article

Similar content 38

Cited by 38

Most referenced authors 409