The association between HIV diagnosis disclosure and adherence to anti-retroviral therapy among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis

Abstract

Introduction Nine in ten of the world’s 1.74 million adolescents living with human immunodeficiency virus (ALHIV) live in Sub-Saharan Africa. Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are important problems among adolescents. To guide intervention efforts in this regard, this review presented pooled estimates on the prevalence of adherence and how it is affected by disclosure of HIV status among ALHIV in Sub-Saharan Africa. Methods A comprehensive search in major databases (Excerpta Medica database (EMBASE), PubMed, Ovid/MEDLINE, HINARI, and Google Scholar) with additional hand searches for grey literature was conducted to locate observational epidemiologic studies published in English up to November 12, 2022 with the following inclusion criteria: primary studies that reported disclosure of HIV status as an exposure variable, had positive adherence to ART as an outcome, and conducted among adolescents and children. The COVIDENCE software was used for a title/abstract screening, full-text screening, the JBI quality assessment checklist, and data extraction. Random effects model was used to pool estimates. Furthermore, sensitivity analysis and subgroup analysis were also conducted by age groups and type of adherence measures used. Results This meta-analysis combines the effect estimates from 12 primary studies with 4422 participants. The prevalence of good adherence to ART was 73% (95% CI (confidence interval): 56 to 87; I2 = 98.63%, P = <0.001), and it was higher among adolescents who were aware of their HIV status, 77% (95% CI: 56 to 92; I2 = 98.34%, P = <0.001). Overall, knowledge of HIV status was associated with increased odds of adherence (odds ratio (OR) = 1.88, 95% CI: 1.21 to 2.94; I2 = 79.8%, P = <0.001). This was further supported in a subgroup analysis by age (seven studies, pooled OR = 1.89, 95% CI: 1.06 to 3.37; I2 = 81.3%, P = <0.0001) and whether primary studies controlled for confounding factors (six studies provided adjusted estimates, pooled OR = 2.61, 95% CI: 1.22 to 5.57; I2 = 88.1%, P = <0.001) confirmed this further. Conclusions Our meta-analysis and systematic review revealed that knowledge of one’s HIV status was associated with adherence to ART, particularly among adolescents. The findings underscored the importance of encouraging disclosure in order to enhance adherence among adolescents.

Experiences of adolescents and youth with HIV testing and linkage to care through the Red Carpet Program (RCP) in Kenya

“…In Kenya, perinatal HIV disclosure rates have been documented as low as 36.6% among AYLHIV [28]. Data from Kenya and other sub-Saharan African countries suggest that disclosure of HIV status to perinatally-infected AYLHIV is associated with improved treatment adherence and immunological status [10,29,30]. Similarly, in our study, disclosure was described to help AYLHIV understand the diagnosis and need for treatment.…”

“…These barriers included stigma, poverty, fear of disclosure, mental health challenges, and limited social support, including non-supportive behavior by healthcare workers [9]. The challenges and complexities AYLHIV experience concerning disclosure of HIV status, stigma, and treatment management are well documented in the literature alongside the implications these experiences have on AYLHIV long-term engagement and retention in care [10]. In school settings, in particular, stigma perpetrated by teachers and peers has been described in published studies from Kenya, where boarding schools are common and many AYLHIV chose not to disclose their HIV status and treatment to the educators and school staff [11,12].…”

Qualitative Study on the Voices of Adolescents Living with Perinatally Acquired HIV in Selected Clinics in the Limpopo Province of South Africa

“…This was corroborated by a study conducted by Kitetele et al (2023), who found that APHIV that were fully disclosed felt like their HIV-negative peers when they had to make informed decisions about sexual relationships [16]. Furthermore, different authors acknowledge the positive association between full disclosure and better adherence to ART, participation in less risky lifestyles, and improved mental health [1,7,19,26].…”

“…However, these adolescents were not disclosed during diagnosis due to their young age and the nature of acquisition. Their status was only disclosed later in life, leading to adverse health outcomes and other problems [1,7].…”

Sociodemographic and health systems determinants of antiretroviral therapy adherence among human immunodeficiency virus-positive patients in the Volta Region of Ghana: A multi-centre study

“…Knowledge of one’s HIV status was a factor in ART adherence among adolescents. 12 , 13 A study among eight SSA countries revealed stigma, ART side effects, lack of resistance and forgetfulness as barriers to ART adherence. 14 The findings of a study conducted in Yaounde, Cameroon proved that poor ART adherence is associated with the presence of depressed mood, virologic failure, disease progression and treatment failure.…”