Trauma-Informed HIV Care Interventions: Towards a Holistic Approach

Brown, Monique J.; Adeagbo, Oluwafemi

doi:10.1007/s11904-022-00603-3

Cited by 14 publications

(11 citation statements)

References 44 publications

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“…Cultural barriers such as religion and use of traditional medicine facilitated by social barriers and therapy-related especially ART knowledge, side effects, WHO stage, stigma, and discrimination negatively impacted on the uptake and adherence of ART. Our study is consistent with studies that showed that personal beliefs, stigma, trust or satisfaction with health care workers, health service-related factors, and social support are main predictors for ART adherence [97,98,[109][110][111]. Nevertheless, findings of this review indicate that these barriers can be addressed through proving social support, ART education and counselling of ALHIV.…”

Section: Discussionsupporting

confidence: 92%

“…The systematic review identified 66 studies which were included in the analysis which expanded on prior review on the same topic; ART adherence among adolescents [97][98][99]. The findings of our review showed that ART adherence was 65% (95% CI [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] and viral suppression was 55% (95% CI [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] This could be explained by the fact that ART adherence facilitators considered a holistic approach to improving ART adherence [109,110]. Rather than focusing on a specific adolescent aspect of ART adherence, as described in the interventions included in the meta-analysis, improving ART adherence may necessitate a more comprehensive approach.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, ART adherence facilitators such as social support, secrecy or confidentiality, counselling, and ART education were effective and acceptable. This could be explained by the fact that ART adherence facilitators considered a holistic approach to improving ART adherence [109, 110]. Rather than focusing on a specific adolescent aspect of ART adherence, as described in the interventions included in the meta-analysis, improving ART adherence may necessitate a more comprehensive approach.…”

Section: Discussionmentioning

confidence: 99%

“…The copyright holder for this preprint this version posted October 10, 2022. ; https://doi.org/10.1101/2022.10.07.22280823 doi: medRxiv preprint social support are main predictors for ART adherence [97,98,[109][110][111]. Nevertheless, findings of this review indicate that these barriers can be addressed through proving social support, ART education and counselling of ALHIV.…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 95%

See 3 more Smart Citations

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review

Hlophe

Tamuzi

Shumba

et al. 2022

Preprint

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Background: Human Immunodeficiency Virus (HIV) significantly affects adolescents globally, with the sub-Saharan Africa (SSA) reporting a high burden of the disease. HIV testing, treatment, and retention to care are low among adolescents. We conducted a mixed-method systematic review to assess anti-retroviral therapy (ART) adherence; barriers and facilitators to ART adherence and ART outcomes among adolescents living with HIV and on ART in sub-Saharan Africa. Methods: We conducted searches in four scientific databases for studies conducted between 2010 and March 2022 to identify relevant primary studies. Studies were screened against inclusion criteria and assessed for quality, and data was extracted. Meta-analysis of rates and odd ratios was used to plot the quantitative studies and meta-synthesis summarized the evidence from qualitative studies. Results: A total of 10 431 studies were identified and screened against the inclusion/ exclusion criteria. Sixty-six studies met the inclusion criteria (41 quantitative, 16 qualitative, and 9 mixed-methods study designs). Fifty-three thousand two hundred and seventeen (53 217) adolescents (52 319 in quantitative studies and 899 in qualitative studies) were included in the review. Thirteen support focused interventions for improved ART adherence were identified from quantitative studies. The plotted results from the meta-analysis found an ART adherence rate of 65% (95%CI 56-74), viral load suppression was 55% (95%CI 46-64), un-suppressed viral load rate of 41% (95%CI 32-50), and loss to follow up of 17% (95%CI 10-24) among adolescents. Meta-synthesis found six themes of barriers to ART (social, patient-based, economic, health system-based, therapy-based, and cultural barriers) in both the qualitative and quantitative studies, and three themes of facilitators to ART were also identified (social support, counselling, and ART education and secrecy or confidentiality) from qualitative studies. Conclusion: ART adherence remains low among adolescents in SSA despite multiple interventions implemented to improve ART adherence. The low adherence rate may hinder the attainment of the UNAIDS 2030 targets. Additionally, various barriers to ART adherence due to lack of support have been reported among this age group. However, interventions aimed at improving social support, educating, and counselling adolescents may improve and sustain ART adherence.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 95%

See 2 more Smart Citations

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review

Hlophe

Tamuzi

Shumba

et al. 2022

Preprint

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“…With the limited availability of psychopharmacology, stepped‐care approaches may begin with brief counselling that targets underlying vulnerabilities across disorders and then escalates to additional treatment and/or a prescription only if symptom reductions and increases in PrEP adherence are not observed. Trauma‐informed HIV care interventions [ 120 ] could be adapted to support adherence to PrEP, and dyadic designs could engage both partners while emphasizing the joint benefits of continued PrEP use (e.g. increased intimacy and improved communication) [ 121 ].…”

Section: Discussionmentioning

confidence: 99%

The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub‐Saharan Africa: state of the science and research priorities

et al. 2022

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Introduction Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.

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Trauma‐informed care: An approach to improve oral health care for people with HIV

York,

Port‐Greenblatt,

Toth

et al. 2023

Journal of Dental Education

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Trauma-Informed HIV Care Interventions: Towards a Holistic Approach

Cited by 14 publications

References 44 publications

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review

The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub‐Saharan Africa: state of the science and research priorities

Trauma‐informed care: An approach to improve oral health care for people with HIV

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