Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa

Katz, Ingrid T.; Bogart, Laura M.; Dietrich, Janan; Leslie, Hannah H; Iyer, Hari S.; Leone, Dominick; Magidson, Jessica F.; Earnshaw, Valerie A.; Courtney, Ingrid; Tshabalala, Gugu; Fitzmaurice, Garrett M.; Orrell, Catherine; Gray, Glenda; Bangsberg, David R.

doi:10.1097/qad.0000000000002175

Cited by 18 publications

(13 citation statements)

References 52 publications

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“…As a result, other avenues of mitigating violence against youth, and the poor psychological outcomes stemming from experienced violence, must be explored. Social support, resilience and selfesteem have been found to improve mental health [9,[17][18][19][20][21][22] and HIV care outcomes [23][24][25][26][27]. These domains could serve as potential intervention targets for mitigating the negative psychological effects of violence in YLWH.…”

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confidence: 99%

Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

Filiatreau

Giovenco

Twine

et al. 2020

J. Intern. AIDS Soc.

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Introduction Experiences of violence during youth contravene young people’s rights and increase the risk of depression and poor human immunodeficiency virus (HIV) care outcomes among youth living with HIV (YLWH). Intervention targets for mitigating the negative psychosocial effects of violence are needed, particularly in areas like rural South Africa where violence remains pervasive and mental healthcare is limited. This study aims to quantify the associations between physical and sexual violence and depressive symptoms in YLWH in rural South Africa and explore the modification of these associations by key measures of psychosocial well‐being. Methods We conducted a cross‐sectional survey among 362 YLWH ages 12 to 24 in rural South Africa to ascertain participants’ history of physical and sexual violence, current depressive symptoms (Center for Epidemiological Studies‐Depression Scale) and levels of social support (Medical Outcomes Social Support Scale), resilience (Conner‐Davidson Resilience Scale) and self‐esteem (Rosenberg Self‐Esteem Scale). Log‐binomial regression was used to estimate the association between history of physical or sexual violence and clinically meaningful depressive symptoms (scores 16). Effect measure modification by high versus low resilience, social support and self‐esteem was assessed using likelihood ratio tests (α = 0.20). Results A total of 334 individuals with a median age of 21 (interquartile range: 16 to 23) were included in this analysis. Most participants were female (71.3%), single (81.4%) and attending school (53.0%). Ninety‐four participants (28.1%) reported a history of physical or sexual violence and 92 individuals (27.5%) had clinically meaningful depressive symptoms. Meaningful depressive symptoms were significantly higher among participants with a history of physical or sexual violence as compared to those with no history of violence (adjusted prevalence ratio: 2.01; 95% CI: 1.43, 2.83). However, this association was significantly modified by social support ( p = 0.04) and self‐esteem ( p = 0.02). Conclusions In this setting, the prevalence of meaningful depressive symptoms was significantly higher among YLWH with a history of physical or sexual violence as compared to those without a history of violence. However, higher levels of self‐esteem or social support appeared to mitigate this association. Programmes to improve self‐esteem and social support for youth have the potential to minimize depressive symptoms in YLWH who have experienced physical or sexual violence.

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confidence: 99%

Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

Filiatreau

Giovenco

Twine

et al. 2020

J. Intern. AIDS Soc.

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“…Thirty‐nine studies reported on initiation of ART [2,21,23,28,33,34,37,40‐42,44‐47,49‐54,23,55‐62,64,66,67‐75], with 25 (64%) defining numerators and denominators. Thirty‐two were longitudinal, four of mixed design and three were cross‐sectional.…”

Section: Resultsmentioning

confidence: 99%

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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Introduction:The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. Methods: We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. Results and discussion: Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013(IQR to 2019. The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. Conclusions: The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.

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“…Significant attrition from the care cascade has been documented consistently throughout the region, despite sweeping changes made to increase access to and availability of antiretroviral therapy (ART) [3][4][5][6][7]. A recent prospective cohort study of 500 PWH presenting for testing in Soweto and Gugulethu townships adds to these data, showing that 62% of treatment-eligible PWH initiated ART, but only 25% had evidence of an undetectable HIV-1 plasma RNA (< 50 copies/ml) within 9 months of testing [8,9].…”

Section: Introductionmentioning

confidence: 99%

The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

et al. 2020

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We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peerbased, behavioral intervention for people with HIV (PWH) in South Africa not on antiretroviral therapy (ART). PWH (43 intervention, 41 controls) completed baseline, 3-and 6-month assessments. TAP was highly feasible (90% completion), with peer counselors demonstrating good intervention fidelity. Post-intervention interviews showed high acceptability of TAP and counselors, who supported autonomy, assisted with clinical navigation, and provided psychosocial support. Intentionto-treat analyses indicated increased ART initiation by 3 months in the intervention vs. control arm (12.2% [5/41] vs. 2.3% [1/43], Fisher exact p-value = 0.105; Cohen's h = 0.41). Among those previously on ART (off for > 6 months), 33.3% initiated ART by 3 months in the intervention vs. 14.3% in the control arm (Cohen's h = 0.45). Results suggest that TAP was highly acceptable and feasible among PWH not on ART.

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Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa

Cited by 18 publications

References 52 publications

Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

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