Amsterdam 2015
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| Abstract #2211 - Treatment adherence | ||||
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Session: 48.4: Treatment adherence (Parallel) on Friday @ 09.00-10.30 in C002 Chaired by Kendra Blackett Dabinga, Aoife Molloy Authors: Presenting Author: Dr Lucie Cluver - Oxford University/University of Cape Town, United Kingdom |
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| Additional Authors: | ||||
| Aim: WHO guidelines recommend disclosure to HIV-positive children by school age in order to improve ART adherence. However, quantitative evidence of these associations remains limited for adolescents. This study examines associations between adolescent knowledge of their own HIV-positive status and ART-adherence in South Africa. | ||||
| Method / Issue: A mixed-methods study in a low-resource health district of the Eastern Cape. Quantitative interviews of N=684 ART-initiated adolescents aged 10-19 (52% female, 79% perinatally-infected) were conducted in the largest known community-traced sample of HIV-positive adolescents worldwide. All adolescents who had ever initiated ART in a stratified sample of 39 health facilities were identified and traced into 150 communities (n=1102, 351 excluded, 27 deceased, 40 (5.5%) refusals). Standardised questionnaires and clinic records were used, and analyses used multivariate logistic regressions. Qualitative methods used 18 months of interviews, focus groups and participant observations with 64 adolescents, their families and their healthcare workers, and analyses used grounded theory. | ||||
| Results / Comments: 36% of adolescents reported past-week ART non-adherence, and 70% of adolescents knew their status. Adherence was associated with fewer opportunistic infection symptoms (OR .55 CI 0.40-0.76). Adolescent knowledge of HIV-positive status was associated with higher adherence (OR 2.18 CI 1.47-3.24), independently of all co-factors of child age, gender, language, urban/rural location, informal housing, household access to basic necessities, presence of biological caregiver, maternal and paternal orphanhood, perinatal/horizontal infection, pill burden and past-year changes of medication, clinic/hospital care, travel time to clinic and visiting clinic alone/accompanied. Among perinatally-infected adolescents who knew their status (n=362/540) disclosure prior to age 12 was associated with higher adherence independently of all co-factors (OR 2.65 CI 1.34-5.22). Qualitative findings suggested that the majority of disclosures were undertaken sensitively in clinical and family settings, and were used as opportunities to improve treatment literacy, and reduce deception and improve trust. Healthcare workers used analogies to help children understand, most commnly describing HIV as a tsotsi [gangster], the adolescent as a policeman, and ART as a weapon: ‘When you drink them [ART], it puts the HIV in jail’. However, adults often lacked awareness about the extent of adolescents’ understanding of their HIV status, including adolescents thinking that disclosure was untrue, or adolescents identifying their status themselves through googling or asking other family members. | ||||
| Discussion: This study strongly supports WHO guidelines of early and full disclosure, showing that this is strongly associated with improved adherence amongst ART-initiated adolescents. Full, enabling and developmentally-appropriate disclosure of their HIV-status to pediatric populations may be a vital tool in promoting adolescent adherence, and thus in reducing mortality and onwards transmission. | ||||
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