Enhancing the Emotional Well-Being of Perinatally HIV-Infected Youth Across Global Contexts

Abstract

Increased access to antiretroviral treatment worldwide makes it more possible for children diagnosed with HIV before their 15th birthday to age into adolescence and beyond. Many HIV+ youth navigate stressors including poverty and resource scarcity, which may converge to produce emotional distress. For over a decade, CHAMP (Collaborative HIV Prevention and Adolescent Mental Health Project) investigators partnered with youth, caregivers, providers and community stakeholders to address the health, mental health and risk taking behaviors of perinatally HIV-infected youth. This paper explores the mental health needs of aging cohorts of HIV+ youth, across three global contexts, New York (U.S.), Buenos Aires (Argentina), and KwaZulu-Natal (South Africa), to inform the development and implementation of combination HIV care and prevention supports for HIV+ youth. Methods Analysis of data pooled across three countries involving HIV+ early adolescents and their caregivers over time (baseline and three month follow-up) was conducted. Univariate and multivariate analyses were applied to data from standardized measures used across sites to identify mental health needs of youth participants. The impact of the site specific versions of a family-strengthening intervention, CHAMP+U.S., CHAMP+Argentina, CHAMP+SA, was also examined relative to a randomized standard of care (SOC) comparison condition. Results Analyses revealed mental health resilience in a large proportion of HIV+ youth, particularly behavioral functioning and overall mental health. Yet, significant numbers of caregivers across country contexts reported impaired child emotional and prosocial wellbeing. Significant site differences emerged at baseline. Involvement in the CHAMP+ Family Program was related to significant improvement in emotional wellbeing and a trend towards enhanced prosocial behavior relative to SOC across global sites. Conclusions Ongoing partnerships with youth, family and provider stakeholders across global sites helped to tailor programs like CHAMP+ to specific contextual needs. This has global intervention research and care implications as cohorts of HIV+ children age into adolescence.

Predictors of mental health problems in adolescents living with HIV in Namibia

“…Interventions strengthening family and caregiver support would be beneficial. Two such interventions in similar low‐resource settings have shown promise for improving mental health, decreasing stigma and improving adherence (Bhana et al., ; Small et al., ). We did not assess poverty eradication initiatives, such as cash‐based transfers and nutritional support programmes, but future studies should determine the proportion of ALHIV accessing these and their impact.…”

“…It contains five subscales assessing emotional symptoms, peer problems, hyperactivity, conduct problems and prosocial behaviours, with the four problem scales generating a score for total mental health difficulties, referred to as the total difficulties scale. The tool has been validated in a range of contexts (Achenbach et al., ), has a high concurrent validity with other measures of psychopathology (Goodman & Scott, ) and has been used in previous studies with ALHIV in Africa (Small et al., ). In our sample, Cronbach's alpha scores were acceptable for the total difficulties ( α = .71) and ranged from 0.57 to 0.51 for subscales, but were low for conduct ( α = .49) and peer problems ( α = .32).…”

“…Studies in sub‐Saharan Africa report mental health problems in ALHIV ranging from around 18% (Small et al., ) to 49% (Kamau, Kuria, Mathai, Atwoli, & Kangethe, ). Few studies have examined risk factors for mental health problems, some pointing to female gender (Kim et al., ), poor health (Kamau et al., ), poverty (Woollett, Cluver, Bandeira, & Brahmbhatt, ), parental loss (Tadesse, Tsehay, Belaineh, & Alemu, ) and stigma (Pantelic, Boyes, Cluver, & Thabeng, ).…”

Adolescent-Caregiver Relationships and Mental Health Outcomes Among Adolescents Living with HIV: A Prospective Cohort Study in South Africa

“…While a small-scale pilot randomised evaluation of Vuka in South Africa did not find statistically significant intervention effects of the programme on adolescent mental health, the pooled data from South Africa, US, and Argentina pilots suggested a trend of improvement in the emotional wellbeing of participating ALHIV, compared to the control groups (19)(20)(21).…”

Adapting Evidence-Based Interventions to Meet the Needs of Adolescents Growing Up with HIV in South Africa: The VUKA Case Example

“…While there are numerous psychosocial clinical efforts to address the mental health and prevention needs of HIV+ adolescents across the globe, to date, CHAMP+ is the only program we know of that is being tested for efficacy and scalability that focuses on behavioral outcomes, including mental health, adherence, and sexual risk reduction. Preliminary evidence of efficacy has been shown in pilot RCTs in three countries, USA, Argentina, and South Africa (VUKA)(Small et al 2014), and we are currently in the second year of a large-scale clinical trial of VUKA in four public health clinics in KwaZulu-Natal, South Africa.…”