Healthcare provisions associated with multiple HIV‐related outcomes among adolescent girls and young women living with HIV in South Africa: a cross‐sectional study

Journal of the International AIDS Society, Journal Year: 2024, Volume and Issue: 27(2)

Published: Feb. 1, 2024

Abstract Introduction Adolescent girls and young women (AGYW) living with HIV experience poor outcomes high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV‐related outcomes, particularly among AGYW mothers. Methods Eligible 12‐ to 24‐year‐old from 61 health facilities in a South African district completed survey 2018–2019 (90% recruited). Analysing surveys medical records n = 774 participants, we investigated associations multiple (past‐week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] viral suppression) seven provisions: antiretroviral therapy (ART) stockouts, kind respectful providers, support groups, short travel time, waiting confidentiality, safe affordable facilities. Further, compared between mothers ( 336) nulliparous participants 438). Analyses used multivariable regression models, accounting for outcomes. Results were poor, especially In analyses, two “accelerators,” associated improved similar results Safe facilities, staff higher predicted probabilities p <0.001): past‐week adherence (62% when neither accelerator was reported 87% both accelerators reported), attendance (71%−89%), ART treatment (57%−85%), TB symptoms (49%−70%) suppression (60%−77%). Conclusions Accessible adolescent‐responsive critical improving reducing morbidity, mortality onward transmission AGYW. Combining these maximize benefits,

Language: Английский

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Increasing Sustained Viral Suppression Among Youth Living with HIV: A Randomized Controlled Trial of Stepped Care Intervention

AIDS and Behavior, Journal Year: 2025, Volume and Issue: unknown

Published: April 5, 2025

Language: Английский

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Better Together: acceptability, feasibility and preliminary impact of chronic illness peer support groups for South African adolescents and young adults

Journal of the International AIDS Society, Journal Year: 2023, Volume and Issue: 26(S4)

Published: Oct. 1, 2023

Abstract Introduction Peer support can help navigate the isolation and psychological strain frequently experienced by youth living with chronic illness. Yet, data are lacking on impact of providing for mixed conditions. We assessed acceptability, feasibility preliminary mental health impacts a clinic‐based peer group South African illnesses, including HIV. Methods This mixed‐methods pilot study (September 2021–June 2022) enrolled 58 young patients, ages 13–24, at an urban hospital in Cape Town, Africa. In‐depth interviews elicited perspectives 20 people relation to their participation Better Together programme, recurring patients illnesses. Self‐reported resilience, attitudes towards illness, stigma were captured via established measures. T ‐tests multivariate analysis variance compared psychosocial outcomes participants 38 control controlling socio‐demographic characteristics enrolment. Logistic regression analyses estimated predicted probability positive depression or anxiety screening given participation. Results All interviewees valued being able compare treatment regimens disease management habits peers different Adolescents HIV stated that understanding hardships faced those other conditions helped them accept own illness lessened feelings isolation. Compared who did not participate , attended ≥5 groups had statistically significantly higher individual‐level more attitude illness(es), lower internalised self‐concept. The screened was 23.4 percentage points (95% CI: 1.5, 45.3) controls; 45.8 18.1, 73.6). Conclusions Recurring, integrate diseases novel. Group sustainability will depend commitment leaders providers, routine scheduling transportation support. A fully powered randomised trial is needed test optimal implementation causal effects model.

Language: Английский

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Effectiveness of a peer educator-coordinated preference-based differentiated service delivery model on viral suppression among young people living with HIV in Lesotho: The PEBRA cluster-randomized trial

PLoS Medicine, Journal Year: 2023, Volume and Issue: 20(1), P. e1004150 - e1004150

Published: Jan. 3, 2023

Southern and Eastern Africa is home to more than 2.1 million young people aged 15 24 years living with HIV. As compared other age groups, this population group has poorer outcomes along the HIV care cascade. Young research team co-created PEBRA (Peer Educator-Based Refill of ART) model. In PEBRA, a peer educator (PE) delivered services as per regularly assessed patient preferences for medication pick-up, short message service (SMS) notifications, psychosocial support. The cluster-randomized trial model versus standard clinic (no PE ART refill done by nurses) in 3 districts Lesotho.Individuals taking antiretroviral therapy (ART) at 20 clinics (clusters) were eligible. 10 randomized intervention arm, participants offered model, coordinated trained supported an eHealth application (PEBRApp). control clusters, received nurse-coordinated without any coordination PE. primary endpoint was 12-month viral suppression below copies/mL. Analyses intention-to-treat adjusted sex. From November 6, 2019 February 4, 2020, we enrolled 307 individuals (150 intervention, 157 control; 218 [71%] female, median 19 [interquartile range, IQR, 17 22]). At 12 months, 99 150 (66%) 95 (61%) arm had (adjusted odds ratio (OR) 1.27; 95% confidence interval [CI] [0.79 2.03]; p = 0.327); 4 (2.7%) 1 (0.6%) died OR 4.12; CI [0.45 37.62]; 0.210); (8%) 23 (14.7%) transferred out 0.53; [0.25 1.13]; 0.099). There no significant differences between arms secondary outcomes. Twenty (11 9 control) lost follow-up over entire study period. main limitation that data collectors clusters also peers; however, they used restricted version PEBRApp collect thus not able provide prospectively registered on ClinicalTrials.gov (NCT03969030).Preference-based peer-coordinated HIV, nurse-based only, did lead conclusive evidence effect suppression.clinicaltrials.gov, NCT03969030, https://clinicaltrials.gov/ct2/show/NCT03969030.

Language: Английский

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HIV and SRH healthcare delivery experiences of South African healthcare workers and adolescents and young people during COVID-19

Psychology Health & Medicine, Journal Year: 2022, Volume and Issue: 27(sup1), P. 155 - 166

Published: Aug. 24, 2022

While substantial research has emerged from the frontlines of COVID-19 pandemic, as well studies with adolescent populations, there been a dearth focused in South Africa on context-specific experiences healthcare workers (HCWs) and adolescents young people (AYP) to whom they provide services. This article documents provision receipt HIV sexual reproductive health (SRH) services during pandemic perspective African HCWs (n = 13) AYP 41, ages 17–29). Findings highlight several barriers accessing comprehensive SRH including lockdown-related mobility restrictions (reported by HCWs), prioritisation above other needs, longer facility waiting times, poor treatment AYP), discomfort perceived stigma having queue outside facilities, fear contracting both groups). reported that continued be available described seeking these – such long-acting reversible contraception, check-ups for their babies medical refills being told because were not considered emergency cases, should return different date. By capturing diverse perspectives groups, our findings reiterate growing call system investments strengthen delivery services, investing appropriate channels communication between providers (for example, through peer supporters or community workers) differentiated models service multi-month ART pick-ups). Closing gap needs who serve them may support buffering against changes brought about pandemic.

Language: Английский

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Emotion regulation as a potential moderator of the association between HIV stigma and nonadherence to antiretroviral therapy among youth living with HIV

Journal of Adolescence, Journal Year: 2024, Volume and Issue: 96(5), P. 1048 - 1064

Published: March 15, 2024

Abstract Introduction Human immunodeficiency virus (HIV)‐related stigma affects adherence to antiretroviral therapy (ART) for youth living with HIV. Emotion regulation strategies such as cognitive reappraisal (reinterpreting adversity mitigate emotional impact) and expressive suppression (inhibiting emotion‐expressive behavior activated by adversity) may moderate the HIV stigma‐ART relationship in this group. Methods Using baseline data from 208 aged 15–24 years enrolled an mHealth ART‐adherence intervention, we performed modified Poisson regressions robust variance between (internalized, anticipated, enacted) ART nonadherence. We tested multiplicative interaction via product terms emotion scores, additive relative excess risk due attributable proportion using dichotomous variables. Results Mean age was 21 years; ≥50% of participants were cisgender male, non‐Hispanic Black, gay‐identifying; 18% reported Confounder‐adjusted showed positive associations each variable Internalized negatively, multiplicatively interacted (as internalized increased, nonadherence increased those low reappraisal). High positively, additively (when high levels either strategy present, dramatically). Conclusion Cognitive protect against stigma's harmful association These modifiable be targeted potentially buffer effects support

Language: Английский

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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

BMJ Global Health, Journal Year: 2023, Volume and Issue: 8(9), P. e012600 - e012600

Published: Sept. 1, 2023

Youth-friendly health service (YFHS) approaches are essential to better outcomes for young people. We evaluated attainment of viral load suppression among people living with HIV (YPLHIV) enrolled in an treatment programme implementing YFHS models Nigeria.A realist evaluation using qualitative and quantitative data from 10 facilities. used information explore how why was attained across different settings describe patterns associations between youth-friendly structures processes care, care retention suppression. To consolidate the theories, we comparative analysis identify necessary sufficient conditions attaining suppression, 30 YPLHIV as cases.Between baseline (2018) study-end (May 2022), coverage increased 8 study The number facilities ≥90% rose two seven, while one facility remained unchanged, another had a decline coverage. Among selected cases, 18 during first test 24 at second test. However, varied contexts. identified interventions key mechanisms that influenced contexts.YFHS can improve people's engagement services, but their effectiveness depends on specific contextual factors influencing response interventions. By exploring contexts, findings will design implementation strategies people, which be relevant achievement global goals eliminate by 2030.

Language: Английский

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A conceptualization and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV: A mixed scoping and systematic review

PLOS Global Public Health, Journal Year: 2024, Volume and Issue: 4(8), P. e0002255 - e0002255

Published: Aug. 12, 2024

Introduction Sub-Saharan Africa bears the greatest burden of HIV, with comorbid mental conditions highly prevalent in people living HIV. It is important to evaluate health adolescents and young adults HIV (AYALHIV) comprehensively by measuring both negative positive psychological constructs. There has been a proliferation interest outcome measures, but evidence their psychometric robustness fragmented. This review sought to: 1) Identify outcomes corresponding measures used AYALHIV sub-Saharan Africa. 2) Critically appraise psychometrics identified measures. Methods analysis Two reviewers independently searched articles PubMed, Scopus, Africa-Wide Information, CINAHL, Psych INFO Google Scholar. Searches were conducted from November 2022 February 2023. separate reviewed retrieved articles. We applied narrative synthesis map key The risk bias across studies was evaluated using COnsensus-based Standards for selection Measurement INstruments (COSMIN) checklist. quality properties rated COSMIN checklist qualitatively synthesized modified Grading Recommendations Assessment, Development, Evaluation Results 15 constructs: body appreciation, confidence, coping, flourishing, meaningfulness, personal control, outlook, resilience, self-management, self-compassion, self-concept, self-efficacy, self-esteem, self-worth transcendence, that had assess ALHIV. most measured constructs coping self-efficacy. Construct validity internal consistency frequently considered, while content structural assessed less often. Conclusions Few performed complete validations; thus, However, this shows initial feasibility low-resource settings. Instead creating new researchers are recommended leverage existing adapt them use and, if appropriate, strive maintain factorial structure facilitate comparisons. Registration PROSPERO- CRD42022325172 .

Language: Английский

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Bolstering Access to HIV-Related Health care in Zimbabwe Among Young Mothers Living With HIV: Lessons Learned on HIV Health Promotion From Zvandiri’s Young Mentor Mother Program

Health Promotion Practice, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 30, 2024

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal transmission are high this population, emphasizing the need for targeted health promotion public programming to improve mothers with HIV. Zvandiri, a non-profit organization Zimbabwe, created Young Mentor Mother (YMM) program response issue. This uses peer-led service delivery conducted by trained HIV, called YMMs. We semi-structured virtual interviews (N = 29) among Zvandiri staff YMMs identify benefits challenges, inform future scaling. applied thematic analyses transcriptions. Participant narratives revealed several themes, including three key from YMM program: (1) peer support, (2) holistic care, (3) women’s empowerment. Participants also shared barriers success program, reflecting two overarching dimensions: related scaling up challenges addressing socio-structural factors. Barriers scale-up included limited funds resources, food insecurity. Socio-structural HIV-related stigma, cultural geographic differences, intimate partner violence (IPV). These align social-ecological model, whereby structural factors (lack funding, insecurity), community (HIV-related socio-cultural differences accepting care), interpersonal (IPV) affect implementation program. recommend adopters tailor model their community, prioritize supporter’s well-being, foster empowerment, adopt care approach.

Language: Английский

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“They test my blood to know how much blood is in my body”: the untapped potential of promoting viral load literacy to support adherence and viral suppression among adolescents living with HIV

Journal of the International AIDS Society, Journal Year: 2023, Volume and Issue: 26(10)

Published: Oct. 1, 2023

Achieving sustained HIV viral suppression is a key strategy to optimize the health and wellbeing of those living with HIV. Sub-optimal adherence antiretroviral therapy (ART) in adolescents young people (AYPLHIV) Southern Africa, due range social contextual factors, including poor mental health, has presented substantial challenge meeting targets aimed towards improving treatment outcomes reducing transmission. With increasing availability load (VL) testing there an opportunity better understand relationship between VL literacy, among adolescents.We conducted qualitative interviews 45 AYPLHIV aged 10-24 years three districts (urban, peri-urban rural) Zimbabwe March August 2021. The sample was purposively selected represent experiences related status disclosure, gender, marital experience. Separate workshops were 18 healthcare workers (HCWs) 20 caregivers existing support mechanisms accessing ART. We used thematic analysis examine adolescent networks, clinic interactions, procedures barriers adherence.VL literacy consistently under-developed participants. Comprehension phrases commonly heard during visits, such as TND (target not detected) "high" "low" VL, understood by older predominantly clinical procedure that enables HCWs monitor adherence. Absent throughout descriptions how improves quality life, likely fosters enhances self-esteem, participation education activities, eliminates risk onward transmission.It imperative we reconsider routine monitoring communicated AYPLHIV. Reframing ART, test results, terms psychosocial benefits can generate be crucial motivating maintain optimal engagement develop self-management approaches they move into adulthood. Access accurate information tailored individual concerns circumstances achieve wellbeing.

Language: Английский

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