Adolescent human immunodeficiency virus self-management: Associations with treatment adherence, viral suppression, sexual risk behaviours and health-related quality of life

Abstract

BackgroundAdolescents living with HIV (ALHIV) represent a growing proportion of the global population of people living with HIV. In 2018, 1 600 000 adolescents [1 100 000; 2 300 000] between the ages of 10 and 19 years were living with HIV. That year, 190 000 were newly infected. 1 Sub-Saharan Africa (SSA) has the highest burden of HIV: 89% of the world's ALHIV reside in this region. Of South Africa's (SA) estimated 460 000 ALHIV, 52 000 new infections and 5 600 AIDS-related deaths were reported in 2018. 1 Adolescents living with HIV can be divided into two groups: perinatally infected adolescents who are diagnosed as infants or children; and behaviourally/horizontally infected adolescents who likely acquired HIV through sexual transmission. 2 One South African study reported 25.4% (n = 269) out of a sample of 1059 adolescents aged 10-19 years acquired HIV horizontally. 3 Perinatally infected adolescents are usually treatment-experienced and more likely to suffer from the chronic effects of HIV infection such as delayed growth and development. 4 Although the healthcare needs of perinatally and behaviourally infected adolescents may differ, shared healthcare concerns include medication non-adherence, risky sexual behaviour, psychosocial stressors and comorbid psychiatric illness. 2,5 Background: With the advent of access to antiretroviral treatment (ART), human immunodeficiency virus (HIV) has become a chronic disease and self-management is an important component of its care. Research to date has not explored associations between adolescent HIV self-management and treatment adherence, viral suppression, sexual risk behaviour and health-related quality of life (HRQoL).Objectives: To explore the associations between adolescent HIV self-management and treatment adherence, viral suppression, sexual risk behaviour and HRQoL. Methods:A quantitative cross-sectional study of 385 adolescents living with HIV (ALHIV) aged 13-18 years, who were recruited from 11 healthcare facilities between March and August 2017 in the Cape Metropole of the Western Cape, South Africa, provided the data that were examined in this self-completed questionnaire. Validated scales were used to measure key variables. The most recent viral load (VL) was obtained from the participants' clinic folder, taking into account that VL is done annually.Results: Adolescents who reported higher HIV self-management were more likely to be adherent to treatment (t = 4.435 [336], p < 0.01), virally suppressed (t = 2.376 [305], p = 0.02) and to practise consistent condom use (t = 1.947 [95], p = 0.54). Structural equation modelling (SEM) indicated a significant relationship between self-management and HRQoL (r = 0.43, p < 0.01), whilst non-adherent treatment taking behaviour, correlated with elevated VL log values. No significant correlation was found between self-management and sexual risk behaviour. Conclusion:Targeting adolescents' skills related to HIV self-management in the clinical setting may improve adolescents' treatment taking behaviour, viral suppression...

Self-management interventions for adolescents living with HIV: a systematic review

“…Self-regulation, especially coping with a stigmatised condition such as HIV, is an important component of HIV self-management for adolescents. Social facilitation and active participation in care was shown to correlate with improved health-related quality of life and adherence amongst ALHIV in South Africa [ 21 ].…”

“…taking treatment and attending appointments) [ 11 ]. The self-management domains described in the IFSMT have been associated with better adherence, health-related quality of life and viral suppression amongst ALHIV [ 21 ]. The assumption is that addressing multiple self-management domains will lead to a larger effect on behavioural and health outcomes.…”

Adolescent human immunodeficiency virus self-management: Needs of adolescents in the Eastern Cape

“… 13 Higher levels of self-management were associated with treatment adherence, viral suppression and better health-related quality of life. 14 …”

Factors associated with HIV viral suppression among adolescents in Kabale district, South Western Uganda

“…The viral suppression rate in this study is higher than that of a study done in Kenya which reported a 59% viral suppression among HIV positive adolescents [ 20 ]. In addition, a study done in South Africa found a viral suppression rate of 65.1% among adolescents [ 21 ]. Similarly, a 62.5% proportion of adolescents were virally suppressed in a study conducted in Tanzania [ 12 ].…”