Behavioral Health and Adult Milestones in Young Adults With Perinatal HIV Infection or Exposure

Abrams, Elaine J.; Mellins, Claude A.; Bucek, Amelia; Dolezal, Curtis; Raymond, Jeannette; Wiznia, Andrew; Jurgrau, Andrea; Bamji, Mahrukh; Leu, Cheng-Shiun; Ng, Yiu Kee Warren

doi:10.1542/peds.2018-0938

Cited by 42 publications

(46 citation statements)

References 50 publications

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“…Fifth, while it is possible there could be selection bias among participants who dropped out of the study prior to the last four FUs (i.e.,4,5,6,7), recent research from CASAH found no significant differences across enrollment characteristics (e.g. age, race, gender, income, HIV-status, caregiver type) between those retained and lost to follow-up (Abrams et al, 2018). However, participants without a psychiatric disorder in both PHIV and PHEU groups were more likely to be lost to follow-up at FU5, but this difference was only significant for PHEU participants.…”

Section: Discussionmentioning

confidence: 93%

Longitudinal trajectories of neurocognitive test performance among individuals with perinatal HIV-infection and -exposure: adolescence through young adulthood

et al. 2019

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There are an estimated 2.1 million youth less than 15 years of age living with HIV globally (the majority perinatally HIV-infected [PHIV]) and millions more perinatally HIV-exposed uninfected (PHEU) youth who are expected to survive through adolescence and into adulthood. The transition from adolescence to young adulthood requires adaptation to more demanding social interactions, academic pressures, and individual responsibilities which each place distinct demands on neurocognitive functions. This study examined trajectories of neurocognitive test performance in the domains of processing speed (PS), working memory (WM), and executive functioning (EF) among PHIV and demographically similar PHEU youth as they age through adolescence into young adulthood. Data for this paper come from 4 time points, spanning approximately 10 years, within the Child and Adolescent Self-Awareness and Health Study (CASAH). Youth age ranged from 15 to 29 years. Longitudinal linear mixed effect models were computed for each test as a function of age, PHIV status, PHIV status by age interaction. Our findings indicate that there are few differences in performance on tests of EF and WM between PHIV and PHEU youth as the age from adolescence to adulthood, though PHEU youth showed significantly better PS as they aged than PHIV youth. Future research is needed to understand these vulnerable youth's neurocognitive trajectories as a function of HIV-infection and -exposure, biological functions and psychosocial stressors.

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Section: Discussionmentioning

confidence: 93%

Longitudinal trajectories of neurocognitive test performance among individuals with perinatal HIV-infection and -exposure: adolescence through young adulthood

et al. 2019

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“…Mental health interventions that equip YLWH with coping and stress-relieving mechanisms may be effective in promoting a positive perspective on living with HIV, which is linked to good ART adherence and improved self-care [6,14,20,32]. This interplay of mental health issues and health maintenance suggests a critical role for strategies that improve resilience for YLWH in facilitating transition of care [20,32,[36][37][38].…”

Section: Individual Domainmentioning

confidence: 99%

Challenges and facilitators of transition from adolescent to adult HIV care among young adults living with HIV in Moshi, Tanzania

et al. 2019

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Introduction Scale up of anti‐retroviral therapy has enabled millions of children infected with HIV to survive into adulthood, requiring transition of care to the adult HIV clinic. This transition period is often met with anxiety and reluctance. Youth who fail to transition may create strain on capacity in the pediatric and adolescent clinics or result in individuals dropping out of care entirely. This study examined challenges and facilitators to the transition among young adults living with HIV in Moshi, Tanzania. Methods From April to June 2017, in‐depth interviews were conducted with young adults aged 18 to 27 years living with HIV in order to capture the spectrum of experiences from pre‐transitioning youth to those who successfully transitioned to adult care. Young adults were purposively recruited based on prior study enrollees and recommendations from healthcare staff. Recruitment occurred in the adolescent, adult HIV and the prevention of mother to child transition clinics at Kilimanjaro Christian Medical Centre. Two separate in‐depth interviews were conducted with eligible participants. Medical records were reviewed retrospectively to collect information on HIV‐related outcomes. Results In‐depth interviews were held with 19 young adults. Participants mean age was 23.8 years (interquartile range 22.2 to 26.3 years); 53% were female. Most (78.9%) participants had been receiving anti‐retroviral therapy for nearly a decade and 72.2% were virologically suppressed (HIV RNA <200 copies/mL). Barriers to transition included fear of losing peer networks formed in the adolescent clinic, the abrupt manner in which young adults were asked to transition, stigma, financial constraints and a lower quality of care in the adult clinic. Facilitators of transition included family and social support, positive perspectives on living with HIV and maintenance of good health. Recommendations for transition included transition preparation, transition as a group and adoption of desirable aspects of the adolescent clinic (peer networks and education) in the adult clinic. Conclusions Transition is a complex process influenced by many factors. As the number of young adults living with HIV continues to grow, it is vital to develop a transition protocol that addresses these challenges and is feasible to implement in low‐resource settings.

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“…Mental health challenges are a critical barrier to ending the HIV epidemic across contexts and populations, given that they increase the risk of non-adherence to ART, poor engagement in care and sexual and substance use risk behaviours for HIV transmission [6][7][8][9]. Studies from multiple countries increasingly show high rates of various mental health problems in AYALH ranging from psychosocial distress and symptoms of emotional and behavioural problems to actual psychiatric disorders [7,[9][10][11][12][13][14], with some studies finding higher rates of mental health problems in youth compared to those with PHIV [15,16].…”

Section: Introductionmentioning

confidence: 99%

Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

et al. 2021

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Introduction Adolescents and young adults (AYA) remain vulnerable to HIV‐infection and significant co‐morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence‐based mental health interventions for AYALH and AYAAH to inform future work. Methods The review, targeting work between 2014 and 2020, initially included studies of evidence‐based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes. Results and discussion We identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub‐Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence‐based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group‐based and family strengthening interventions, economic empowerment combined with family strengthening, group‐based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group‐based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health. Conclusions Despite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence‐based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.

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Behavioral Health and Adult Milestones in Young Adults With Perinatal HIV Infection or Exposure

Cited by 42 publications

References 50 publications

Longitudinal trajectories of neurocognitive test performance among individuals with perinatal HIV-infection and -exposure: adolescence through young adulthood

Longitudinal trajectories of neurocognitive test performance among individuals with perinatal HIV-infection and -exposure: adolescence through young adulthood

Challenges and facilitators of transition from adolescent to adult HIV care among young adults living with HIV in Moshi, Tanzania

Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

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