Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis

Badejo, Okikiolu; Nöstlinger, Christiana; Wouters, Edwin; Laga, Marie; Okonkwo, Prosper; Jwanle, Plang; Van Belle, Sara

doi:10.1136/bmjgh-2023-012600

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…Our observation of AYA in the consent and proximity class suggests that limitation in autonomy could be a common driver of non-utilisation of HIV testing services and observed sex behaviour [ 34 , 51 ]. Specifically, intergenerational and transactional sex, and multiple concurrent sexual relationships shown in this group have all been linked with limited autonomy within the family or marital context with relationship power imbalances [ 16 , 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

Badejo,

Wouters,

Van Belle

et al. 2024

PLoS ONE

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Introduction Adolescents and young adults (AYA) face multiple barriers to accessing healthcare services, which can interact, creating complex needs that often impact health behaviours, leading to increased vulnerability to HIV. We aimed to identify distinct AYA subgroups based on patterns of barriers to HIV testing services and assess the association between these barrier patterns and sexual behaviour, socio-demographics, and HIV status. Methods Data were from Nigeria’s AIDS Indicator and Impact Survey (NAIIS, 2018) and included 18,612 sexually active AYA aged 15–24 years who had never been tested for HIV and reported barriers to accessing HIV testing services. A Latent class analysis (LCA) model was built from 12 self-reported barrier types to identify distinct subgroups of AYA based on barrier patterns. Latent class regressions (LCR) were conducted to compare the socio-demographics, sexual behaviour, and HIV status across identified AYA subgroups. Sex behaviour characteristics include intergenerational sex, transactional sex, multiple sex partners, condom use, and knowledge of partner’s HIV status. Results Our LCA model identified four distinct AYA subgroups termed ’low-risk perception’ (n = 7,361; 39.5%), ’consent and proximity’ (n = 5,163; 27.74%), ’testing site’ (n = 4,996; 26.84%), and ’cost and logistics’ (n = 1,092; 5.87%). Compared to adolescents and young adults (AYA) in the low-risk perception class, those in the consent and proximity class were more likely to report engaging in intergenerational sex (aOR 1.17, 95% CI 1.02–1.35), transactional sex (aOR 1.50, 95% CI 1.23–1.84), and have multiple sex partners (aOR 1.75, 95% CI 1.39–2.20), while being less likely to report condom use (aOR 0.79, 95% CI 0.63–0.99). AYA in the testing site class were more likely to report intergenerational sex (aOR 1.21, 95% CI 1.04–1.39) and transactional sex (aOR 1.53, 95% CI 1.26–1.85). AYA in the cost and logistics class were more likely to engage in transactional sex (aOR 2.12, 95% CI 1.58–2.84) and less likely to report condom use (aOR 0.58, 95% CI 0.34–0.98). There was no significant relationship between barrier subgroup membership and HIV status. However, being female, aged 15–24 years, married or cohabiting, residing in the Southsouth zone, and of Christian religion increased the likelihood of being HIV infected. Conclusions Patterns of barriers to HIV testing are linked with differences in sexual behaviour and sociodemographic profiles among AYA, with the latter driving differences in HIV status. Findings can improve combination healthcare packages aimed at simultaneously addressing multiple barriers and determinants of vulnerability to HIV among AYA.

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Section: Discussionmentioning

confidence: 99%

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

Badejo,

Wouters,

Van Belle

et al. 2024

PLoS ONE

Self Cite

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Adolescents and young adults with HIV and unsuppressed viral load: where do we go from here?

Rakhmanina,

Foster,

Agwu

2024

Current Opinion in HIV and AIDS

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Purpose of review Adolescents and youth living with HIV (AYLHIV) have worse outcomes at all stages of the care cascade when compared with adults, yet adolescents and youth with unsuppressed viral load are typically excluded from phase 3 studies of novel HIV therapeutic agents and emerging strategies. Long-acting agents have the potential to radically change outcomes for young people struggling with adherence to daily oral HIV medications. Recent findings 1.5 million children aged less than 15 years live with HIV and more than 100 000 acquire HIV perinatally every year. Adolescents and youth aged 10–24 years comprise ∼40% of global incident HIV infections. Rates of viral suppression among AYLHIV vary markedly from 44 to 88%, resulting in morbidity and risks of transmission to partners and infants. Virological failure is mostly due to poor adherence, and AYLHIV express high levels of interest and acceptability of alternatives to oral daily medications, such as long-acting antiretroviral formulations. Emerging data regarding their use in populations with unsuppressed viral load are encouraging. Summary AYLHIV, including populations without virologic suppression, must be prioritized for the programmatic implementation and research of long-acting HIV drugs and other therapeutic strategies to prevent morbidity and mortality and to ultimately end the HIV epidemic.

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Cost-effectiveness of an interactive voice response system for improving retention in care and adherence to antiretroviral therapy among young adults in Uganda

Naggirinya,

Nuwamanya,

Nabaggala

et al. 2024

BMC Digit Health

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Background New interventions aimed at increasing access to and adherence to antiretroviral therapy among young people living with the human immunodeficiency virus (YPLHIV) are needed. This study assessed the cost-effectiveness of the call-for-life interaction voice response tool compared to that of the standard of care (SOC) for promoting treatment adherence and retention in care among YPLHIV in Western Uganda. This cost-effectiveness study used data from a randomized controlled trial and a decision-analytic Markov model to estimate the long-term outcomes and costs of the Call for Life-Interactive Voice Response (CFL-IVR) tool and the usual care from the Ugandan public payer perspective. The model was parameterized using primary data and the literature and adopted a 1-year Markov cycle. The main outcomes were mean annual costs, disability-adjusted life-years (DALYs), and the incremental cost-effectiveness ratio (ICER) in form of cost per DALY averted. The CLF-IVR was deemed cost-effective if the ICER was between 1% and 51% of Uganda’s gross domestic product. We conducted deterministic and probabilistic sensitivity analyses to assess the effect of adjusting parameter values on cost-effectiveness estimates. All costs were reported in 2021 US dollars, and a discount rate of 3% was applied to both costs and outcomes. Results The base case analysis showed that, from the Ugandan public payer perspective, the CLF-IVR led to more mean annual costs ($359 vs. $280) and averted more mean annual DALYs (15.78 vs. 11.09) than the SOC, leading to an ICER of $17 per DALY averted. The base-case results did not change significantly in the deterministic and probabilistic sensitivity analyses. The cost-effectiveness estimates were more responsive to uncertainties surrounding ART duration, viral load suppression rates, and discount rates. Conclusion The CLF-IVR may be a cost-effective intervention for promoting treatment adherence and retention in care among YPLHIV in Uganda and other low-income settings. Once implemented, similar interventions may lead to greater returns in encouraging adherence to ART and retention in care among YPLHIV and other vulnerable groups, and eventually favorable clinical outcomes. Trial registration NCT04718974 Registry: clinical Trials.gov https://ichgcp.net/nl/clinical-trials-registry/NCT04718974 (20 Jan 2021).

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Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis

Cited by 3 publications

References 47 publications

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

Adolescents and young adults with HIV and unsuppressed viral load: where do we go from here?

Cost-effectiveness of an interactive voice response system for improving retention in care and adherence to antiretroviral therapy among young adults in Uganda

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