Psychosocial Support for Youth Living With HIV

Abstract

This clinical report provides guidance for the pediatrician in addressing the psychosocial needs of adolescents and young adults living with HIV, which can improve linkage to care and adherence to life-saving antiretroviral (ARV) therapy. Recent national case surveillance data for youth (defined here as adolescents and young adults 13 to 24 years of age) revealed that the burden of HIV/AIDS fell most heavily and disproportionately on African American youth, particularly males having sex with males. To effectively increase linkage to care and sustain adherence to therapy, interventions should address the immediate drivers of ARV compliance and also address factors that provide broader social and structural support for HIV-infected adolescents and young adults. Interventions should address psychosocial development, including lack of future orientation, inadequate educational attainment and limited health literacy, failure to focus on the long-term consequences of near-term risk behaviors, and coping ability. Associated challenges are closely linked to the structural environment. Individual case management is essential to linkage to and retention in care, ARV adherence, and management of associated comorbidities. Integrating these skills into pediatric and adolescent HIV practice in a medical home setting is critical, given the alarming increase in new HIV infections in youth in the United States.

Internalized HIV stigma, bullying, major depressive disorder, and high-risk suicidality among HIV-positive adolescents in rural Uganda

“…Of note is the fact that our sample consisted of adolescents who were on antiretroviral therapy for an average of more than 8 years. Although ALWH engaged in care have access to support, and HIV treatment in general has been shown to diminish stigma (Seeley & Russell, 2010 ; Campbell et al 2011 ; Mbonye et al 2013 ; Tsai et al 2013 a ), our findings indicate that ALWH still experience persistent internalized HIV stigma, bullying, and other mental health problems including depression even when on long-term antiretroviral therapy (Martinez et al 2014 a ; Treves-Kagan et al 2016 ). As such there is a room to enhance psychological services for adolescents in HIV care to enhance antiretroviral treatment adherence and improve treatment outcomes (Dow et al 2016 ; McHenry et al 2016 ; Vreeman et al 2017 ).…”

A practical approach to reporting treatment abandonment in pediatric chronic conditions

“…The profile of inconsistency category refers to inconsistent adherence to prescribed management. This includes nonadherence and irregular treatment as patterns in health behaviors, with concerning implications for vulnerable groups including adolescents, across an array of pediatric chronic conditions [25][26][27][28][29][30][31][32]. This category warrants documentation of longitudinal direct adherence measures (e.g., appointment attendance, drug/metabolite levels) and indirect measures (e.g., pill counts, refill timing).…”

Clinician Attitudes Toward CDC Interim Pre-Exposure Prophylaxis (PrEP) Guidance and Operationalizing PrEP for Adolescents

“…In addition, the guidance is designed for adults over age 18 years, which is the age group for which PrEP is FDA-approved. Because the clinicians in this study have experience caring for HIV-infected adolescents who face great psychosocial challenges, 32 these clinicians may perceive that adolescents receiving PrEP need more intensive support and monitoring.…”