Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling

Storyboarding HIV Infected Young People's Adherence to Antiretroviral Therapy in Lower- to Upper Middle-Income Countries: A New-Materialist Qualitative Evidence Synthesis

Young people living with perinatal infections of Human Immunodeficiency Virus (YLPHIV) face a chronic disease, with treatment including adherence to lifelong antiretroviral treatment (ART). The aim of this QES was to explore adherence to ART for YLPHIV as an assemblage within the framework of the biopsychosocial model with a new materialist perspective. We searched up to November 2021 and followed the ENTREQ and Cochrane guidelines for QES. All screening, data extraction, and critical appraisal were done in duplicate. We analysed and interpreted the findings innovatively by creating images of meaning, a storyboard, and storylines. We then reported the findings in a first-person narrative story. We included 47 studies and identified 9 storylines. We found that treatment adherence has less to do with humans' preferences, motivations, needs, and dispositions and more to do with how bodies, viruses, things, ideas, institutions, environments, social processes, and social structures assemble. This QES highlights that adherence to ART for YLPHIV is a multisensorial experience in a multi-agentic world. Future research into rethinking the linear and casual inferences we are accustomed to in evidence-based health care is needed if we are to adopt multidisciplinary approaches to address pressing issues such as adherence to ART.

Life skills and sexual risk behaviors among adolescents in Indonesia: A cross-sectional survey

Background

Adolescents require life skills and individual and interpersonal abilities to grow into adults with a healthy lifestyle. Although the majority of the literature indicates that life skills increase teenagers' cognitive, social, and emotional abilities, there is a lack of data correlating life skills to sexual risk behaviors.

Objective

This study aimed to examine the relationship between life skills and sexual risk behaviors among adolescents aged 15-19 in Bandung, Indonesia.

Methods

This study was conducted using a cross-sectional survey of 480 adolescents from April to May 2021. A representative sample was drawn from the students aged 15-19 years. The participants were selected using simple random sampling generated by computer software. Life Skill Training Questionnaire High School (LSTQ-HS) and sexual risk behaviors instruments were used for data collection, and logistic regression was used for data analysis.

Results

From a total of 480 respondents, about 23.3% had masturbation experience, 25.8% had petting experience, 8.3% had sexual intercourse, 5% had sex before 18 years of age, and 4.2% had oral sex experience. Sexual risky behaviors were associated with unfavorable refusal skill (AOR = 6.46, 95% CI = 2.37, 17.53), assertiveness skill (AOR = 3.51, 95% CI = 1.32, 4.33), problem-solving skill (AOR = 5.35, 95% CI = 2.88, 11.39), and self-control skill (AOR = 7.31, 95% CI = 2.79, 17.24).

Conclusion

Life skills are important protective aspects for those who engage in sexually risky behavior. Considering the study findings, tailored life skills programs are critical for adolescent wellbeing and risk reduction. Nurses who take a proactive role in providing sexual and reproductive health services may provide more accurate information and provide early screening and assessment for sexual and reproductive behavior to reduce risky sexual behavior among adolescents. Schools are also encouraged to work with local health departments to conduct sexual education counseling programs.

Sexual behaviors related to HIV infection in Yi women of childbearing age in rural areas of southwest China

Liangshan Prefecture, the highest HIV-affected epidemic region in China, has more than 2.5 million Yi people. We firstly investigated the sexual behaviors and the related social determinants of health for HIV infection in Yi women of childbearing age in this area. A total of 800 Yi women of childbearing age were enrolled. Path analysis of the risk factors revealed that casual sex (0.152) and number of sex partners (0.152) were directly associated with HIV infection. Furthermore, education level (0.057), out-migrating for work (0.032), sense of self-worth (0.024) and number of sex partners (0.079) were indirectly related to HIV infection and mediated by casual sex and multiple sexual partners. The epidemic of HIV infection among Yi women of childbearing age in Liangshan Prefecture is serious, future promotion should increase their knowledge about condom and modify their perceptions of sexual behaviors.

CHAMP+ Thailand: Pilot Randomized Control Trial of a Family-Based Psychosocial Intervention for Perinatally HIV-Infected Early Adolescents

Within Asia, HIV prevalence is highest in Thailand, including thousands of children and adolescents. Care for children born with HIV [perinatal transmission of HIV (PHIV)] will need to focus on adolescents for the foreseeable future. Thai PHIV adolescents experience significant mental health and psychosocial challenges, including treatment adherence. Yet, few, if any, comprehensive interventions for them exist. CHAMP+, an evidence-based intervention adapted for Thailand, was evaluated with a pilot randomized control trial at four HIV clinics. Eighty-eight dyads of 9- to 14-year-old PHIV young adolescents/caregivers were randomized to CHAMP+ or standard of care (SOC). Eleven cartoon-based sessions were delivered over 6 months. Participants completed baseline, 6-month (postintervention), and 9-month surveys, measuring youth outcomes (e.g., mental health and adherence), contextual factors (e.g., demographics and caregiver factors), and self- and social-regulation factors (e.g., HIV knowledge and youth-caregiver communication). Multi-level modeling to account for clustering within individuals was used to assess longitudinal changes within and between groups. All families randomized to CHAMP+ completed the intervention. Although the study was not statistically powered to detect differences in treatment effects, the CHAMP+ group significantly improved at 6 months in youth mental health and adherence, HIV knowledge, youth-caregiver communication, internalized stigma, and HIV-related social support, with most improvements sustained at 9 months and significantly better improvements than the SOC group on a number of outcomes. High levels of baseline viral suppression highlight the importance of reaching these young PHIV adolescents at a period of lower risk before adherence and other challenges emerge. Designed to be delivered with limited cost/resources, CHAMP+ Thailand holds scale-up potential.

The Happy Teen programme: a holistic outpatient clinic-based approach to prepare HIV-infected youth for the transition from paediatric to adult medical care services in Thailand

Introduction: We developed an 18‐month Happy Teen 2 (HT2) programme comprised of a one‐day workshop, two half‐day sessions, and three individual sessions to prepare HIV‐infected youth for the transition from paediatric to adult HIV care services. We describe the programme and evaluate the change in youth's knowledge scores.

Methods: We implemented the HT2 programme among HIV‐infected Thai youth aged 14–22 years who were aware of their HIV status and receiving care at two hospitals in Bangkok (Siriraj Hospital, Queen Sirikit National Institute of Child Health [QSNICH]). Staff interviewed youth using a standardized questionnaire to assess HIV and health‐related knowledge at baseline and at 12 and 18 months while they participated in the programme. We examined factors associated with a composite knowledge score ≥95% at month 18 using logistic regression.

Results: During March 2014–July 2016, 192 of 245 (78%) eligible youth were interviewed at baseline. Of these, 161 (84%) returned for interviews at 12 and 18 months. Among the 161 youth, the median age was 17 years, 74 (46%) were female, and 99% were receiving antiretroviral treatment. The median composite score was 45% at baseline and increased to 82% at 12 months and 95% at 18 months (P < 0.001). The range of median knowledge scores for antiretroviral management, HIV monitoring, HIV services, and family planning significantly increased from baseline (range 0–75%) to (range 67–100%) at 12 months and to 100% at 18 months (P < 0.001). Almost all youth were able to describe education and career goals at 12 and 18 months compared to 75% at baseline. In multivariable analysis, a composite knowledge score at 18 months >95% was associated with education level >high school (aOR: 2.15, 95%CI, 1.03–4.48) and receipt care at QSNICH (aOR: 2.43, 95%CI, 1.18–4.98). Youth whose mother and father had died were less likely to have score ≥95% (aOR: 0.22, 95%CI, 0.07–0.67) than those with living parents.

Conclusions: Knowledge useful for a successful transition from paediatric to adult HIV care increased among youth participating in the HT2 programme. Youth follow‐up will continue to assess the impact of improved knowledge on outcomes following the transition to adult care services.