Disability, social functioning and school inclusion among older children and adolescents living with HIV in Zimbabwe

Rukuni, Ruramayi; McHugh, Grace; Majonga, Edith; Kranzer, Katharina; Mujuru, Hilda; Munyati, Shungu; Nathoo, Kusum; Gregson, Celia L; Kuper, Hannah; Ferrand, Rashida A

doi:10.1111/tmi.13012

Cited by 22 publications

(33 citation statements)

References 28 publications

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“…However, among adolescents living in family settings, school attendance was lower among ALPHIV than among general population controls (83% vs. 94%, respectively). Also, as observed (8,12,28), the percentage of academic delay ≥ 1 year among ALPHIV was significantly higher than among controls (17% vs. 4%), similar to the proportion of 20% found in another study among HIV-infected children aged 6-12 years in Thailand (28).…”

Section: Discussionsupporting

confidence: 85%

“…In the TEEWA survey, school attendance was high, above 85%, for both ALPHIV and controls, in the upper range compared to other studies in various age groups (8)(9)(10)(11)(12)14). However, among adolescents living in family settings, school attendance was lower among ALPHIV than among general population controls (83% vs. 94%, respectively).…”

Section: Discussionmentioning

confidence: 56%

“…In the TEEWA survey, about 20% of ALPHIV mentioned episodes or extended periods of school absenteeism for medical reasons. In a recent cross-sectional study, Rukuni et al found that HIV-infected children were not only more likely to repeat a grade but that their risk of social and educational exclusion increased in case of disabilities (12). In the TEEWA survey, after adjustment, delayed development was significantly associated with disrupted school trajectories.…”

Section: Discussionmentioning

confidence: 98%

“…In a recent study in South Africa, Fotso et al found that HIV-infection significantly reduced adolescent school attainment and that contextual factors could only explain 18% of the attainment gap (8). While neurocognitive impairments connected to HIV-infection can directly impact academic achievements, school absenteeism for frequent illness or HIV-related stigmatization could mediate the negative effect of HIV-infection on school life (6,11,12,14). In the TEEWA survey, about 20% of ALPHIV mentioned episodes or extended periods of school absenteeism for medical reasons.…”

Section: Discussionmentioning

confidence: 99%

“…Perinatally HIV-infected children and adolescents often experience difficult living circumstances, such as parental loss, foster care, poverty and stigmatization, which can also have a negative impact on their educational achievements (6). However, studies on their educational achievements are heterogeneous in terms of age groups, study populations, access to ART, outcomes and comparison group (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

Merville

Puangmala²,

Suksawas

et al. 2020

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Background: In the HIV/AIDS pandemic, the perinatally HIV-infected children, who are surviving to adolescence, constitute a particular group, with specific needs to manage HIV disease and to prepare their future. Adolescents living with perinatal HIV (ALPHIV) often experience difficult living circumstances that can impact educational achievement and thus, insertion in the adult life. We explore the school trajectories of ALPHIV and determine the relative contribution of HIV-infection and the contextual environment to their schooling situations.Methods: We used data from the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional case-control study, conducted from 2011 to 2014 in Thailand. We analysed data for 707 ALPHIV (cases) aged 12–19 years, receiving antiretroviral therapy in 20 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected in the general population and individually matched for sex, age and residence. Schooling disruption was defined as ≥1 year academic delay or early school dropout. Logistic regression was used to assess factors independently associated with schooling disruption and to estimate the attributable fraction of school disruption related to HIV-infection. We used multivariate imputations by chained equations to manage missing data and we performed two sensitivity analyses to evaluate the reliability of our main model.Results: ALPHIV were 5 times more likely to experience schooling disruption than controls after adjustment on sociodemographic factors ( ORA=5.2 [3.7-7.2]). About 50% of schooling disruption could be attributed to HIV-infection. Boys and adolescents living in institutions were more likely to experience schooling disruption (ORA =1.8 [1.3-2.4] and ORA =11.0 [7.7-15.8], respectively). Among ALPHIV, mental and growth delays were significantly associated with schooling disruption (ORA =3.3 [2.1-5.2] and =1.8 [1.3-2.6], respectively). For ALPHIV living in family, schooling disruption was also associated with stigmatization experiences (ORA =1.9 [1.2-3.1]) and caregiver’s low education (ORA =2.1 [1.1-3.9]). Conclusions: HIV and contextual factors combine to aggravate ALPHIV educational disadvantage. Further research is needed to clarify the pathways leading to a disrupted school trajectory among ALPHIV. The impact of this educational disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be explored in future research.

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