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Roach MAE, Loeb T, Rao A, Lyons C, Turpin G, Syarif O, Looze P, Lalak K, Anoubissi J, Brion S, Dunaway K, Sprague L, Garcia de Leon Moreno C, Matyushina D, Ayeh E, Baral S, Rucinski K. Experiences of Disclosure, Resilience and Viral Suppression among People Living with HIV in Ghana. AIDS Behav 2025; 29:1729-1737. [PMID: 39883370 PMCID: PMC12074885 DOI: 10.1007/s10461-025-04641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2025] [Indexed: 01/31/2025]
Abstract
Support for people living with HIV (PLHIV) as they disclose their HIV status can impact continuity of HIV treatment and adherence to antiretrovirals. In the presence of multi-level adversities, resilience among PLHIV can promote health-seeking behaviors and better health outcomes. However, few studies have examined how disclosure experience and resilience work together to impact HIV treatment outcomes among PLHIV. In this study, we assessed the relationships between HIV disclosure experience, resilience and viral suppression among PLHIV in Ghana. The Stigma Index 2.0 questionnaire was completed by 1827 PLHIV in Ghana in 2021 to assess demographics, experiences of HIV related stigma, resilience-factors, and other self-reported outcomes including viral suppression. Participants were also asked to classify their disclosure experience with friends and family as positive or negative. Multivariable log-binomial models estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the association between disclosure experience and viral suppression. A dichotomized measure of resilience was evaluated as a potential effect measure modifier, and subgroup analyses explored associations by key population. Overall, those with a positive disclosure experience were more likely to have achieved viral suppression than participants with a negative disclosure experience (PR 1.09, 95%CI:1.00-1.19). This association increased among participants with lower resilience scores (PR 1.33, 95%CI:1.11-1.60). Findings suggest the importance of early positive social interactions for sustained engagement in ART, particularly for marginalized populations who face psychosocial and structural stigmas that challenge resilience. Ultimately, optimizing HIV treatment necessitates interventions that mitigate community stigma and promote resilience-building strategies for PLHIV in Ghana.
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Affiliation(s)
- Mary Anne Elizabeth Roach
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Talia Loeb
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Gnilane Turpin
- Global Network of People Living with HIV (GNP+), Amsterdam, Netherlands
| | - Omar Syarif
- Global Network of People Living with HIV (GNP+), Amsterdam, Netherlands
| | - Pim Looze
- Global Network of People Living with HIV (GNP+), Amsterdam, Netherlands
| | - Katarzyna Lalak
- Global Network of People Living with HIV (GNP+), Amsterdam, Netherlands
| | - Jean Anoubissi
- Global Network of People Living with HIV (GNP+), Amsterdam, Netherlands
| | - Sophie Brion
- The International Committee of Women Living with HIV (ICW), London, UK
| | - Keren Dunaway
- The International Committee of Women Living with HIV (ICW), London, UK
| | | | | | | | - Elsie Ayeh
- Global Network of People Living with HIV (GNP+), Amsterdam, Netherlands
- Pan African Positive Women's Coalition (PAPWC), Kadoma, Zimbabwe
- Ghana Network of Persons Living with HIV, Accra, Ghana
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Katherine Rucinski
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Fonner VA, Yeh PT, Kennedy CE, O'Reilly KR, Sweat MD. Better Together?: A Systematic Review of the Effectiveness of HIV Prevention Interventions that Build or Strengthen Social Ties. AIDS Behav 2025:10.1007/s10461-025-04745-4. [PMID: 40369304 DOI: 10.1007/s10461-025-04745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2025] [Indexed: 05/16/2025]
Abstract
Although social relationships impact health and social dynamics play a key role in shaping HIV vulnerability, results from intentional efforts to build or strengthen social relationships have not been synthesized to understand if and how such interventions work to prevent HIV in low- and middle-income countries (LMICs). We conducted a systematic review of HIV prevention interventions implemented in LMICs, published between 2010 and 2022, that used pre/post or multi-arm methods to evaluate interventions that focused on building/strengthening social relationships to impact HIV-related outcomes. We searched PubMed, CINAHL, EMBASE, Sociological Abstracts, and PsycInfo on August 16, 2022, complemented by hand-searching and secondary reference searching. We used a standardized form for data abstraction and assessed risk of bias using the Evidence Project tool. Results were synthesized narratively, and studies were classified in an emergent typology based on the function of social tie building within the intervention. Fifty-one articles presenting results from 28 studies met the inclusion criteria and were included. Within these studies, we identified five types of social tie interventions, including community-wide social mobilization ("collaboration", n = 3), formation of collectives to address both upstream and downstream health-related factors ("collectivization", n = 13), forming or strengthening groups to enhance peer support and build skills ("clubs", n = 4), expanding personal networks among individuals ("companionship", n = 2), and strengthening ties between heterogeneous groups/non-peers ("connections", n = 2). Four studies addressed two or more types of social ties strengthening and were classified as "cross-cutting." Across these categories, most studies found that interventions were associated with some positive health-related changes, such as reduced HIV incidence, increased condom use, and increased health service utilization. However, some interventions fell short of their stated goals, especially those striving to impact upstream social and structural factors. Overall, results suggest that social ties can be intentionally altered to effect change; however, disparate contexts and implementation dynamics likely contributed to variation seen across outcomes and impact. Inconsistent measurement of social ties and use of theory made it challenging to determine whether interventions were explicitly trying to alter ties, and if so, to what extent tie building/strengthening impacted intervention effectiveness. To continue advancing our understanding of social tie interventions, more efforts are needed to operationalize theory, measure social tie constructs, describe intervention context and implementation outcomes, and apply innovative study designs.
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Affiliation(s)
- Virginia A Fonner
- Global Programs and Science, FHI 360 359 Blackwell St #200, Durham, NC, 27701, USA
| | - Ping Teresa Yeh
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kevin R O'Reilly
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Michael D Sweat
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
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Tinman JS, Nzama N, Patterson J, Harris LM, Kerr JC. "Don't Tell Nobody Nothing": A Phenomenological Study on Fear of HIV Disclosure Among Older African Americans During Incarceration Living in Kentucky, USA. J Assoc Nurses AIDS Care 2025; 36:130-142. [PMID: 39718385 DOI: 10.1097/jnc.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2024]
Abstract
ABSTRACT The intersections of HIV with aging, incarceration, and racial disparities have been well studied, but little is known about the lived incarceration experiences of older African American persons living with HIV. This phenomenological study examined the fear of HIV disclosure among older African Americans living in Kentucky who have experienced incarceration. Based on the interviews analyzed, five main themes were identified: experiences with fear, experiences pertaining to confidentiality, experiences with disclosure, experiences with stigma, and the desire to be accepted. These themes demonstrate HIV disclosure fear within incarceration settings and the desire for support and services. Findings suggest that there should be more efforts to increase HIV knowledge and awareness within incarceration settings. Participants shared that having a support network alleviates isolation. We recommend that correctional settings implement policies to protect confidentiality violations and facilitate groups to help foster a more supportive environment for individuals living with HIV.
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Affiliation(s)
- Jennifer S Tinman
- Jennifer S. Tinman, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Nqobile Nzama, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Jenifer Patterson, RN, MSN, ARNP, is a PhD student, School of Nursing, University of Louisville, Louisville, Kentucky, USA
- Lesley M. Harris, PhD, MSW, is an Associate Professor, Kent School of Social Work, University of Louisville, Kentucky, USA
- Jelani C. Kerr, MSPH, PhD, is an Associate Professor, Department of Health Promotion and Behavioral Sciences, University of Louisville, Kentucky, USA
| | - Nqobile Nzama
- Jennifer S. Tinman, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Nqobile Nzama, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Jenifer Patterson, RN, MSN, ARNP, is a PhD student, School of Nursing, University of Louisville, Louisville, Kentucky, USA
- Lesley M. Harris, PhD, MSW, is an Associate Professor, Kent School of Social Work, University of Louisville, Kentucky, USA
- Jelani C. Kerr, MSPH, PhD, is an Associate Professor, Department of Health Promotion and Behavioral Sciences, University of Louisville, Kentucky, USA
| | - Jenifer Patterson
- Jennifer S. Tinman, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Nqobile Nzama, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Jenifer Patterson, RN, MSN, ARNP, is a PhD student, School of Nursing, University of Louisville, Louisville, Kentucky, USA
- Lesley M. Harris, PhD, MSW, is an Associate Professor, Kent School of Social Work, University of Louisville, Kentucky, USA
- Jelani C. Kerr, MSPH, PhD, is an Associate Professor, Department of Health Promotion and Behavioral Sciences, University of Louisville, Kentucky, USA
| | - Lesley M Harris
- Jennifer S. Tinman, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Nqobile Nzama, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Jenifer Patterson, RN, MSN, ARNP, is a PhD student, School of Nursing, University of Louisville, Louisville, Kentucky, USA
- Lesley M. Harris, PhD, MSW, is an Associate Professor, Kent School of Social Work, University of Louisville, Kentucky, USA
- Jelani C. Kerr, MSPH, PhD, is an Associate Professor, Department of Health Promotion and Behavioral Sciences, University of Louisville, Kentucky, USA
| | - Jelani C Kerr
- Jennifer S. Tinman, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Nqobile Nzama, MPH, is a PhD student, Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
- Jenifer Patterson, RN, MSN, ARNP, is a PhD student, School of Nursing, University of Louisville, Louisville, Kentucky, USA
- Lesley M. Harris, PhD, MSW, is an Associate Professor, Kent School of Social Work, University of Louisville, Kentucky, USA
- Jelani C. Kerr, MSPH, PhD, is an Associate Professor, Department of Health Promotion and Behavioral Sciences, University of Louisville, Kentucky, USA
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Sardarzehi R, Seyed Alinaghi SA, Kianimoghadam AS, Masjedi-Arani A, Bakhtiari M, Dehghan Manshadi SA, Mohraz M. An empirical test of the chronic illness quality of life model: the prominent role of barrier to health care and social support. AIDS Care 2024; 36:1795-1804. [PMID: 39047158 DOI: 10.1080/09540121.2024.2378375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
The Chronic Illness Quality of Life (CIQOL) model highlights satisfaction with life in individuals with a chronic illness (i.e., HIV-related diseases) determined by factors such as barriers to health care, AIDS-related discrimination, social support, physical well-being, and engagement coping. Despite the empirical evidence supporting the CIQOL model, its validation in the Iranian population has not yet been conducted. This study aimed to validate the CIQOL model among Iranian patients with HIV-related diseases. Four hundred fifty-two patients completed the study questionnaire including Barriers to Care Scale (BACS), Satisfaction with Life Scale (SWLS), Chronic Illness Anticipated Stigma Scale (CIASS), Social Provision Scale (SPS), The Functional Assessment of Human Immunodeficiency Virus Infection (FAHI), and the Brief COPE Scale. Structural equation modeling (SEM) was used to analyze the data. The assumed model demonstrated an acceptable level of fit to study data. Findings showed that this model could explain 39% of variances in life satisfaction in Iranian patients with HIV-related diseases. Therefore, in psychological interventions aimed at enhancing life satisfaction, the CIQOL model factors especially barriers to health care and social support can be taken into consideration.
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Affiliation(s)
- Reyhaneh Sardarzehi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Seyed Alinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sam Kianimoghadam
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Masjedi-Arani
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Bakhtiari
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Department of Infectious Diseases and Tropical Medicine, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Campbell LS, Knight L, Masquillier C, Wouters E. Including the Household: Individual, Community and Household Factors Affecting Antiretroviral Therapy Adherence After ART Initiation in Cape Town, South Africa. AIDS Behav 2024; 28:3733-3747. [PMID: 39090458 PMCID: PMC11471705 DOI: 10.1007/s10461-024-04447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/04/2024]
Abstract
Antiretroviral therapy (ART) adherence is crucial for health outcomes of people living with HIV (PLHIV), influenced by a complex interplay of individual, community, and household factors. This article focuses on the influence of household factors, as well as individual and community factors, on ART adherence among PLHIV in Cape Town who have recently initiated ART. Baseline data for a cluster-randomized controlled trial were collected from 316 PLHIV in 12 districts in Cape Town between 6th May 2021 and 22nd May 2022. Zero-inflated Poisson models, with cluster-adjusted standard errors, were used to analyse the association between individual, household, and community factors and ART adherence measures. At the household-level, household support was associated with both better self-rated adherence (exp(β) = 0.81, z = - 4.68, p < 0.001) and fewer days when pills were missed (exp(β) = 0.65, z = - 2.92, p = 0.003). Psychological violence (exp(β) = 1.37, z = 1.97, p = 0.05) and higher household asset scores (exp(β) = 1.29, z = - 2.83, p = 0.05) were weakly associated with poorer ART adherence. At the individual-level, male gender (exp(β) = 1.37, z = 3.95, p < 0.001) and reinitiating ART (exp(β) = 1.35, z = 3.64, p < 0.001) were associated with worse self-rated ART adherence; higher education levels (exp(β) = 0.30 times, z = - 3.75, p < 0.001) and better HIV knowledge (exp(β) = 0.28, z = - 2.83, p = 0.005) were associated with fewer days where pills were missed. At the community-level, community stigma was associated with worse self-rated ART adherence (exp(β) = 1.24, z = 3.01, p = 0.003). When designing interventions to improve ART adherence, household, individual and community factors should all be considered, particularly in addressing gender-based disparities, reducing stigma, tackling violence, and enhancing household support.Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.
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Affiliation(s)
- Linda S Campbell
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Caroline Masquillier
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
- Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Luthuli MQ, John-Langba J. Interaction of social support and depressive symptoms on antiretroviral therapy adherence among people living with HIV in South Africa. Health SA 2024; 29:2271. [PMID: 38962293 PMCID: PMC11219710 DOI: 10.4102/hsag.v29i0.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/10/2023] [Indexed: 07/05/2024] Open
Abstract
Background Depression consistently emerges as a significant predictor of poor antiretroviral therapy (ART) adherence among adult people living with human immunodeficiency virus (PLHIV). However, a gap exists regarding how social support and depressive symptoms can interact to influence ART adherence among adult PLHIV in South Africa (SA). Aim To investigate the interaction between social support and depressive symptoms on ART adherence among adult PLHIV. Setting A tertiary hospital in Durban, KwaZulu-Natal province of SA. Methods Utilising a quantitative cross-sectional research design along with time location sampling technique (TLS); the study recruited 201 adult patients enrolled in an ART programme. Results The results indicated that depressive symptoms were significantly associated with ART adherence with and without the interaction (B = -0.105; odds ratios [OR] 0.901; 95% confidence intervals [CI] = 0.827, 0.981; p = 0.016), while social support was not significantly associated with ART adherence (B = 0.007; OR 1.007; 95%CI = 0.989, 1.025; p = 0.475). However, a statistically significant interaction was found between social support and depressive symptoms (B = -0.006; OR 0.994; 95%CI = 0.989, 1.000; p = 0.037) on ART adherence. Conclusion Based on the results, depressive symptoms significantly influenced ART adherence. However, social support did not buffer the adverse effects of clinical depression associated with poor ART adherence. Contribution This study provides an evidence-based approach to address gaps in the mental health and social well-being of PLHIV in the context of ART adherence.
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Affiliation(s)
- Muziwandile Q Luthuli
- Discipline of Social Work, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Johannes John-Langba
- Discipline of Social Work, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
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Moore ED, Caiola C, Cary M, Humphreys J. A Qualitative Study of the Social Relationship Experiences Across the Life Course Among Black/African American Women Aging With HIV in the South. J Assoc Nurses AIDS Care 2024; 35:122-134. [PMID: 38261540 DOI: 10.1097/jnc.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
ABSTRACT Black/African American women continue to be disproportionately affected by HIV, facing multiple intersecting challenges that influence how they age and effectively manage their health. Supportive social relationships have been shown to help mitigate challenges and improve health in women with HIV, but little is known about Black/African American women's perceptions of social relationships. Guided by Life Course Theory, in-depth life history interviews were conducted with 18 Black/African American women aged 50+ years. In older adulthood, most important relationships among Black/African American women were with their adult children and grandchildren, intimate partners, God, and friends from the community. Factors that influenced relationships over time included: (a) a desire to build a community; (b) a need to empower oneself and give back; (c) yearning to engage the younger generation; and (d) battling HIV stigma. Older Black/African American women with HIV played a critical role in the education of the younger generation.
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Affiliation(s)
- Elizabeth D Moore
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Courtney Caiola
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Michael Cary
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Janice Humphreys
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
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Ameyaw EK, Nutor JJ, Okiring J, Yeboah I, Agbadi P, Getahun M, Agbadi W, Thompson RGA. The role of social support in antiretroviral therapy uptake and retention among pregnant and postpartum women living with HIV in the Greater Accra region of Ghana. BMC Public Health 2024; 24:540. [PMID: 38383341 PMCID: PMC10882784 DOI: 10.1186/s12889-024-18004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION The role of social support in antiretroviral therapy (ART) uptake and retention among pregnant and postpartum women in Ghana's capital, Accra, has received limited attention in the literature. This cross-sectional study extends existing knowledge by investigating the role of social support in ART adherence and retention among pregnant and postpartum women in Accra. METHODS We implemented a cross-sectional study in eleven (11) public health facilities. Convenience sampling approach was used to recruit 180 participants, out of which 176 with completed data were included in the study. ART adherence in the three months preceding the survey (termed consistent uptake), and ART retention were the outcomes of interest. Initial analysis included descriptive statistics characterized by frequencies and percentages to describe the study population. In model building, we included all variables that had p-values of 0.2 or lesser in the bivariate analysis to minimize negative confounding. Overall, a two-sided p-value of < 0.05 was considered statistically significant. Data were analyzed using Stata version 14.1 (College Station, TX). RESULTS In the multivariate model, we realized a lower odds trend between social support score and consistent ART adherence, however, this was insignificant. Similarly, both the univariate and multivariate models showed that social support has no relationship with ART retention. Meanwhile, urban residents had a higher prevalence of ART adherence (adjusted Prevalence ratio (aPR) = 2.04, CI = 1.12-3.73) relative to rural/peri-urban residents. As compared to those below age 30, women aged 30-34 (aPR = 0.58, CI = 0.34-0.98) and above 35 (aPR = 0.48, CI = 0.31-0.72) had lower prevalence of ART adherence Women who knew their partner's HIV status had lower prevalence of ART adherence compared to those who did not know (aPR = 0.62, CI = 0.43-0.91). Also, having a rival or co-wife was significantly associated with ART retention such that higher prevalence of ART adherence among women with rivals relative to those without rivals (aOR = 1.98, CI = 1.16-3.36). CONCLUSION Our study showed that social support does not play any essential role in ART adherence among the surveyed pregnant and postpartum women. Meanwhile, factors such as having a rival and being under the age of thirty play an instrumental role. The study has signaled the need for ART retention scale-up interventions to have a multi-pronged approach in order to identify the multitude of underlying factors, beyond social support, that enhance/impede efforts to achieve higher uptake and retention rates.
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Affiliation(s)
- Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong, China
- Africa Interdisciplinary Research Institute, Accra, Ghana
- L & E Research Consult Ltd, Wa, Upper West Region, Ghana
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Isaac Yeboah
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Institute of Work Employment and Society, University of Professional Studies, Accra, Ghana
| | - Pascal Agbadi
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Department of Sociology and Social Science Policy, Lingnan University, Hong Kong, China
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Wisdom Agbadi
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Push Aid Africa, Accra, Ghana
| | - Rachel G A Thompson
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
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