Predictors and Evolution of Antiretroviral Therapy Adherence Among Perinatally HIV-Infected Adolescents in Brazil

Côté, José; Delmas, Philippe; Succi, Regina Célia de Menezes; Galano, Eliana; Auger, Patricia; Sylvain, Hélène; Colson, Sébastien; Machado, Daisy Maria

doi:10.1016/j.jadohealth.2016.05.004

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Non-adherence to treatment is frequent, sometimes indicating psycho-social situations (e.g. lack of self-efficacy) which need attention [76], while family social isolation, stigma (and resulting issues around disclosure [77]), anxiety and depression, and substance misuse are examples of common challenges that affect treatment outcomes of children and adolescents. Some of these situations can be identified and addressed during follow-up of adolescents and their caregivers [73,78,79].…”

Section: Resultsmentioning

confidence: 99%

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Bailey

Cruz

Songtaweesin

et al. 2017

Journal of the International AIDS Society

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Introduction: The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities.Methods: We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes.Results and discussion: The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed.Conclusions: Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

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Section: Resultsmentioning

confidence: 99%

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Bailey

Cruz

Songtaweesin

et al. 2017

Journal of the International AIDS Society

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“…[ 26 ] But the association between depression and ART adherence has been found only in studies where the prevalence of depression was high. [ 18 , 22 ] However, in studies where the level of depression is less than 10%, no association was found, either in children [ 27 ] or in adults. [ 28 ]…”

Section: Discussionmentioning

confidence: 99%

“…Based on the sum of these scores, depressive symptoms are classified as insignificant (score of 0–4), mild, [ 5 – 9 ] moderate, [ 10 – 14 ] moderately severe [ 15 – 19 ] or severe. [ 20 – 27 ] In the present study, participants with PHQ-9 score ≥9 were classified as having symptoms suggestive of depression. This threshold has been used in another study that has reported on the performance of the PHQ-9 in a similarly aged population.…”

Section: Methodsmentioning

confidence: 99%

Association between depressive symptoms and adherence among adolescents living with HIV in the Republic of Congo

et al. 2020

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The increasing availability of antiretroviral therapy (ART) worldwide is yet to result in decreasing HIV-related mortality among adolescents (10–19 years old) living with HIV (ALHIV) in part because of poor adherence. the poor adherence might itself be due to high level of depression. We assess the prevalence of depressive symptomatology and it's associated with adherence among ALHIV receiving ART care in Brazzaville and Pointe Noire, Republic of Congo (RoC). Adolescents aged 10 to 19 years, on antiretroviral therapy (ART), followed in the two Ambulatory Treatment Centers (ATC) in Brazzaville and Pointe Noire, RoC were included in this cross-sectional study. From April 19 to July 9, 2018, participants were administered face to face interviews using a standardized questionnaire that included the nine-item Patient Health Questionnaire (PHQ-9). Participants who reported failing to take their ART more than twice in the 7 days preceding the interview were classified as non-adherent. Bivariate and multivariable log-binomial models were used to estimate the prevalence ratio (PR) and 95% confidence interval (95%CI) assessing the strength of association between predictors and presence of depressive symptoms (PHQ-9 score ≥9). Overall, 135 adolescents represented 50% of ALHIV in active care at the 2 clinics were interviewed. Of those, 67 (50%) were male, 81 (60%) were 15 to 19 years old, 124 (95%) had been perinatally infected, and 71 (53%) knew their HIV status. Depressive symptoms were present in 52 (39%) participants and 78 (58%) were adherent. In univariate analyses, the prevalence of depressive symptoms was relative higher among participants who were not adherent compared to those who were (73% vs 33%; PR: 2.20 [95%CI: 1.42–3.41]). In multivariate analysis, after adjustment for report of been sexually active, alcohol drinking, age category (10–14 and 15–19), not in school, loss of both parents, the association between depression and adherence was strengthened (PR: 2.06 [95%CI: 1.23–3.45]). The prevalence of depressive symptoms in adolescents living with HIV is high and was strongly associated with poor adherence even after adjustment of potential confounders. Efforts to scale-up access to screening and management of depression among ALHIV in sub-Saharan is needed for them to realize the full of ART.

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“…Another study also observed a link between good adherence and confidence in remaining adherent [27]. High perception of self‐efficacy (confidence in their own ability to use ART) or greater HIV self‐management, in addition to the use of devices that help adherence to therapy, were associated with good adherence to ART [14, 28, 29].…”

Section: Resultsmentioning

confidence: 99%

Virological failure and adherence to antiretroviral therapy in adolescents and young adults living with human immunodeficiency virus

Daltro

Almeida

Unfried

et al. 2023

Tropical Med Int Health

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Objective: HIV (human immunodeficiency virus) infection remains a major public health challenge. Infected young people at any age are less likely to adhere to care in a timely manner and to maintain a suppressed VL. This review aims to identify factors associated with virologic failure and adherence to drug therapy in adolescents and young adults (10-24 years) living with HIV. Methods: Systematic review using the PubMed and Virtual Health Library databases and including articles published between 2009 and 2021. Data were analysed in six categories: individual factors, pharmacological/therapy-related aspects, factors related to HIV/acquired immunodeficiency syndrome (AIDS) infection, HIV/AIDS stigma, social support and health system/services. The study's protocol was registered on the PROSPERO platform (CRD42020167581). Results: A total of 19,819 articles were found in the initial search and 31 studies were included in this systematic review. Most studies were carried out on the African continent. Male sex, alcohol use, low education, adverse effects of medication, lack of social support, stigma related to HIV/AIDS, need for transportation to access the health service and forgetfulness were linked to poor adherence to therapy. Good adherence was achieved with sufficient nutrition, good social support, greater confidence in the use of therapy and fewer ART side effects. Low levels of CD4, alcohol use, substance abuse, low education, non-adherence to medication and forgetfulness were linked to virological failure. Conclusion: Individual, social and structural factors constitute barriers to adherence to ART among adolescent and young adults. It is necessary to know the difficulties related to the use of therapy to work out specific strategies that create conditions to improve medication adherence and viral suppression, reducing the levels of virological failure in this population.

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Predictors and Evolution of Antiretroviral Therapy Adherence Among Perinatally HIV-Infected Adolescents in Brazil

Cited by 7 publications

References 22 publications

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Association between depressive symptoms and adherence among adolescents living with HIV in the Republic of Congo

Virological failure and adherence to antiretroviral therapy in adolescents and young adults living with human immunodeficiency virus

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