Risk factors for suboptimal antiretroviral therapy adherence in HIV-infected adolescents in Gaborone, Botswana: a pilot cross-sectional study

Ndiaye, Maimouna; Nyasulu, Peter; Nguyễn, Hoàng Dũng; Lowenthal, Elizabeth; Gross, Robert; Mills, Edward J.; Nachega, Jean B.

doi:10.2147/ppa.s47628

Cited by 22 publications

(32 citation statements)

References 19 publications

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“…Eight studies were conducted in South Africa [ 27 – 34 ], seven in Uganda [ 35 – 42 ], four in Zambia [ 43 – 46 ] and four in Kenya [ 47 – 50 ]. Two studies were completed in each of the following countries: Zimbabwe [ 51 , 52 ], Malawi [ 18 , 53 ], Botswana [ 54 , 55 ] and Ghana [ 56 , 57 ]. One study was conducted in both Uganda and Zimbabwe [ 58 ] and another study was conducted in both Uganda and Kenya [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…Another study by Nachega et al (2009) indicated that it was undertaken in Southern African countries, but the exact countries in the southern African region were not specified [ 61 ]. Among the 36 included studies 17 were qualitative [ 18 , 27 , 28 , 33 , 34 , 40 , 43 – 47 , 52 – 54 , 56 – 58 ], 12 were quantitative [ 29 , 31 , 35 , 37 , 38 , 41 , 48 , 50 , 55 , 59 – 61 ], and seven were mixed methods [ 30 , 32 , 36 , 39 , 49 , 51 , 57 ]. Overall, 28 were cross-sectional studies [ 18 , 27 – 30 , 32 – 36 , 39 – 41 , 43 – 54 , 56 , 57 ], six were cohort studies [ 37 , 55 , 58 – 61 ] and two were randomised controlled trials [ 31 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

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Risky behaviours and their correlates among adolescents living with HIV in sub-Saharan Africa: a systematic review

Zgambo¹,

Kalembo

Mbakaya³

2018

Reprod Health

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BackgroundAdolescents living with HIV (ALWHIV) in sub-Saharan Africa encounter multiple health problems that are often unrecognised by the public and the healthcare workforce. The aim of this systematic review was to identify risky health behaviours and their associated factors among ALWHIV in sub-Saharan Africa.MethodsWe systematically searched for articles in Medline, SCOPUS, Directory of Open Access Journals, Science Direct, ProQuest, Psych-info, Web of science, WHO Global Index Medicus library, Cochrane, and Google Scholar. Studies were included in this review if: they were original studies; participants were aged from 10 to 19 years; participants were ALWHIV or they had data from different key informants focusing on ALWHIV within the age group; they had health behaviours as an outcome; they were conducted in sub-Saharan Africa and were published before December 2016. Data were extracted and the quality of the studies was appraised using the Mixed Method Appraisal Tool (MMAT).ResultsThirty-six studies met the eligibility criteria. Nineteen studies scored 100% (indicating high quality), sixteen studies scored 75% (indicating moderate quality) and one study scored 50% (indicating low quality) on the MMAT scale. Adherence to antiretroviral therapy among ALWHIV was suboptimal and was negatively affected by forgetfulness, opportunistic infection, long distance to clinics, and fear of unplanned disclosure. Many adolescents were sexually active, but the majority did not disclose their HIV status to sexual partners, despite knowing their diagnosis (range 76–100% across available studies) and some did not use protection (condoms) to prevent transmission of HIV and other sexually transmitted diseases (range 35–55%). Disclosure to and from adolescents was low across the studies and was associated with fear of disclosure aftermaths including stigma and discrimination (range 40–57%).ConclusionA considerable proportion of ALWHIV in sub-Saharan Africa engage in multiple risky health behaviours, which have a substantial negative impact on their wellbeing and cause significant risk and burden to their families, sexual partners and societies.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0614-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risky behaviours and their correlates among adolescents living with HIV in sub-Saharan Africa: a systematic review

Zgambo¹,

Kalembo

Mbakaya³

2018

Reprod Health

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“…Poor adherence can lead to viral rebound, disease progression, and drug resistance which can compromise patient clinical outcomes and increase the risk of transmitting resistant strains of HIV to others when adolescents become sexually active [4,[6][7][8]. Unfortunately, adherence to ART among children and adolescents is suboptimal [4,5,9,10]. A recent systematic review and meta-analysis [4] that included over 50 studies globally found that only 62.3% of the adolescent and young adult (AYA) population were classified as adherent to therapy assessed by self-report and plasma viral HIV RNA load (VL) levels (adherence at least 85% on self-report or undetectable blood plasma virus levels).…”

Section: Introductionmentioning

confidence: 99%

High self‐reported non‐adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors

Kim

Mazenga²,

et al. 2017

Journal of the International AIDS Society

144

123

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Introduction: Globally adolescents and young adults account for more than 40% of new HIV infections, and HIV-related deaths amongst adolescents increased by 50% from 2005 to 2012. Adherence to antiretroviral therapy (ART) is critical to control viral replication and preserve health; however, there is a paucity of research on adherence amongst the growing population of adolescents living with HIV/AIDS (ALHIV) in Southern Africa. We examined levels of self-reported ART adherence, barriers to adherence, and factors associated with non-adherence amongst ALHIV in Malawi.Methods: Cross-sectional study of 519 ALHIV (12–18 years) attending two large HIV clinics in central and south-eastern Malawi. Participants self-reported missed doses (past week/month), barriers to adherence, and completed questionnaires on past traumatic events/stressors, disclosure, depression, substance use, treatment self-efficacy, and social support. Biomedical data were retrieved from existing medical records. Multivariate logistic regression was performed to identify factors independently associated with self-reported ART adherence (7 day recall).Results: The mean age of participants (SD) was 14.5 (2) years and 290 (56%) were female. Of the 519 participants, 153 (30%) reported having missed ART doses within the past week, and 234 (45%) in the past month. Commonly reported barriers to adherence included forgetting (39%), travel from home (14%), busy with other things (11%), feeling depressed/overwhelmed (6%), feeling stigmatized by people outside (5%) and within the home (3%). Factors found to be independently associated with missing a dose in the past week were drinking alcohol in the past month (OR 4.96, 95% CI [1.41–17.4]), missed clinic appointment in the past 6 months (OR 2.23, 95% CI [1.43–3.49]), witnessed or experienced violence in the home (OR 1.86, 95% CI [1.08–3.21]), and poor treatment self-efficacy (OR 1.55 95% CI [1.02–2.34]). Sex and age were not associated with adherence.Conclusions: In our study, nearly half of all ALHIV reported non-adherence to ART in the past month. Violence in the home or alcohol use in the past year as well as poor treatment self-efficacy were associated with worse adherence. Sub-optimal adherence is a major issue for ALHIV and compromise treatment outcomes. Programmes specifically tailored to address those challenges most pertinent to ALHIV may help improve adherence to ART.

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“…Having a parent or caregiver present at clinical visits appears to be protective of adherence and treatment outcomes among adolescents (18, 19). Adherence has been inconsistently associated with gender (17, 18, 20, 21) and orphan/caregiver status (21–23). Lack of caregiver involvement was incorporated into our definition of a positive PSC as we classified non-completion of the PSC as a positive score.…”

Section: Discussionmentioning

confidence: 99%

Prediction of HIV Virologic Failure Among Adolescents Using the Pediatric Symptom Checklist

et al. 2015

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Psychosocial dysfunction is a risk factor for treatment non-adherence among children and adolescents. A previous study showed that high scores on the Pediatric Symptom Checklist (PSC) were associated with a history of HIV virologic failure. We assessed whether high scores on the PSC could predict virologic failure in HIV-infected youth. Caregivers of 234 adolescents between the ages of 10 and 16 years were asked to complete a PSC at baseline. Elevated PSC scores were associated with virologic failure in the subsequent 6 months. PSC scores may help guide resource utilization when viral load monitoring is limited.

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Risk factors for suboptimal antiretroviral therapy adherence in HIV-infected adolescents in Gaborone, Botswana: a pilot cross-sectional study

Cited by 22 publications

References 19 publications

Risky behaviours and their correlates among adolescents living with HIV in sub-Saharan Africa: a systematic review

Risky behaviours and their correlates among adolescents living with HIV in sub-Saharan Africa: a systematic review

High self‐reported non‐adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors

Prediction of HIV Virologic Failure Among Adolescents Using the Pediatric Symptom Checklist

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