Viral suppression among adolescents on HIV treatment in the Sedibeng District, Gauteng province

"I-We-I": Visualizing Adolescents' Perceptions and Apprehension to Transition to Adult HIV Care at a Supportive Transition Facility in the Cape Town Metropole, South Africa

Adolescents living with HIV (ALHIV) (10-19 years) make up approximately 4.2% (320,000) of people living with HIV in South Africa. Adolescence is a developmental period characterized by pervasive biological, social and psychological changes, which challenges adherence and retention in care for ALHIV on antiretroviral therapy (ART). Further, as ALHIV grow "older", they are expected to transition to the adult HIV treatment programme, where they should assume greater responsibility for managing their chronic condition and healthcare pathway. Whereas it is imperative that ALHIV are transitioned when they are ready, little is known about the challenges and experiences of ALHIV before and during transition. The aim of this paper was to report on the experiences and challenges of transition for ALHIV who received ART at an adolescent-friendly service that is adjunct to a public primary healthcare facility in the Western Cape province of South Africa.

METHODS

Photovoice methods were employed to explore the transition experiences of ALHIV on ART at a "supportive transition" public health facility in the Cape Town Metro in South Africa. Participants took pictures that depict their experience pre- and during transition to adult care and discussed these in groups with peers. Audio data were digitally recorded and transcribed verbatim and subjected to thematic analysis using Atlas.Ti version 24.

RESULTS

The emergent themes described their apprehension to transitioning to adult care; self-management; challenges to adherence; the need for psychosocial support; and how adolescent-friendly services were filling the gap.

CONCLUSIONS

We illuminate the "I-We-I" configuration, to reflect (the first "I") individual ALHIV experiences as isolated before being transferred to the supportive facility; how they experience a sense of belonging and family ("we") in the supportive facility; but face apprehension about transitioning to adult care in the local clinic, where they have to self-manage (final "I").

Tracking viral control in adolescents on antiretroviral therapy in Lusaka, Zambia: A retrospective cohort analysis

Background

In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10-19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15-24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018.

Objectives

To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10-19 years) on ART in Lusaka District, Zambia.

Method

A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29.

Results

The adolescent cohort in Lusaka achieved 91.8% viral suppression rate (< 1000 copies/mL), with 79% fully suppressed (< 50 copies/mL). In multivariate analysis, older adolescents (15-19 years) had lower odds of suppression compared to younger adolescents (10-14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI] : 1.32-2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23-8.11) and optimal adherence (AOR = 1.89; CI: 1.03-3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45-0.80).

Conclusion

Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents.

Prevalence of detectable viral load and its associated factors among adult patients receiving ART in Choma District, Zambia

BACKGROUND

Africa accounts for two-thirds of the global HIV infection and a disproportionate burden is in sub-Saharan Africa. In 2017, the Zambian government launched the U = U campaign which has proven to be key in the prevention of HIV. However, there is a paucity of empirical evidence on the magnitude of detectable viral load in Choma district. This study aimed to estimate the proportion of detectable viral load and identify the associated factors among adults living with HIV receiving antiretroviral therapy (ART) in Choma District, Zambia.

METHODS

This was a cross-sectional study among adults aged 15 years and older on ART ≥ 12 months. Sociodemographic, clinical and laboratory data were collected through a structured questionnaire and data collection form for secondary data from medical records. Detectable Viral load (primary outcome) and Virological failure (secondary outcome) were defined as viral load (VL) > 200cp/ml and VL > 1000cp/ml respectively. The data collected was then analysed using STATA version XII. Descriptive statistics, chi-square test, Wilcoxon rank sum test, and logistic regression were the statistical methods used.

RESULTS

There was a total of 448 participants. The median (interquartile range (IQR)) age was 41 years (32, 49) of whom 284 (63.2%) were females. The prevalence of detectable and virological failure were 10.3% (n = 46; 95% confidence interval (CI) 7.6, 13.5) and 5.4% (n = 24; 95%CI 3.5, 7.9) respectively. In multivariable analysis, detectable VL was significantly associated with young age (16 - 24 years) (odds ratio (OR) 3.38; 95%CI 1.04, 10.94; p = 0.042), no formal education (OR 3.32; 95%CI 1.06, 10.40; p = 0.040), missing medication (OR 3.99; 95%CI 1.83, 8.73; p = 0.001) and problem taking medication (OR 2.74; 95%CI 1.10; 6.84; p < 0.030); while factors associated with virological failure were being in age group 16 - 24 years (OR 7.28; 95%CI 1.62, 32.68, p = 0.009), male gender (OR 3.12; 95%CI 1.25, 7.76; p = 0.014), Missing taking medication (OR 8.28; 95%CI 2.59, 26.40; p < 0.001) and taking dolutegravir-based regimen with zidovudine/lamivudine backbone (OR 17.80 95% CI 2.29 - 132.31; p = 0.005).

CONCLUSION

Detectable VL and virological failure were prevalent among adults receiving ART for ≥ 12 months and were significantly associated with sociodemographic and clinical factors. There is a need for targeted interventions, especially among young people and males to accelerate the attaining of the last 95 of the UNAIDS target; which is imperative in the prevention of HIV transmission. Qualitative research which aims to get an in-depth understanding of why men and young people do not attain optimal viral suppression is encouraged.

Can Support Groups Improve Treatment Adherence and Reduce Sexual Risk Behavior among Young People Living with HIV? Results from a Cohort Study in South Africa

Adolescents and young adults living with HIV (AYLHIV) in sub-Saharan Africa experience poorer HIV outcomes than adults, including lower ART adherence and virologic suppression. They also have high rates of unprotected sex, increasing the risk of adverse sexual health outcomes and onward transmission. This one-arm, pre-post study investigates a structured 14-session support group aiming to boost treatment adherence and sexual protective behavior for AYLHIV in South Africa. Logistic and Poisson regression analyses were performed on self-reported pre- and post-intervention survey data collected approximately 7.5 months apart from a cohort of 548 AYLHIV. Participants were significantly more likely to report at least 95% adherence at follow-up and rate their health as "good;" they also demonstrated greater treatment knowledge and had fewer absences from school overall and due to illness. Among sexually active AYLHIV, contraception use at last sex increased significantly, while condom use did not. Effects were small, and greater programmatic emphasis on adherence and multifaceted service packages is likely necessary to promote viral suppression. Nonetheless, the intervention addresses an important gap in service provision for AYLHIV in South Africa. Findings denote the potential for incorporating care and treatment components into sexual and reproductive health interventions tailored for AYLHIV.

COVID-19 pandemic stressors, familial discord, and anxiety among adolescents living with HIV in South Africa: pathways to non-adherence

Adolescents living with HIV (ALHIV) have poorer adherence to antiretroviral treatment (ART). This study investigates the interconnectivity of stressors induced by the COVID-19 pandemic, anxiety and family dynamics on adolescents' adherence to ART. A telephone survey was conducted among 196 South African ALHIV previously enrolled in support groups. Generalized structural equations modeling was used to understand how pandemic-related stressors affected ART adherence. Respondents reported experiencing life stressors since the implementation of COVID-19 restrictions, including doing worse at school (32%), loss of household income (44%) and less food available (38%). Forty-two percent reported greater verbal aggression from adults at home and 60% experienced anxiety. The structural equations model demonstrated a direct path from experiencing life stressors to increased verbal aggression from caregivers, which led to anxiety and ultimately, poorer ART adherence. Each stressor experienced increased the odds of experiencing verbal aggression by 51% (OR=1.51, 95%CI=1.14-2.00) which, in turn, increased the odds of having anxiety four-fold (OR=4.1, 95%C =2.16-7.76). Anxiety was associated with a 74% reduction in the odds of being fully ART adherent (OR=0.26, 95%CI=0.08-0.81). COVID-19-induced stressors exacerbated the mental and physical vulnerability of ALHIV. Findings elucidate how both discord at home and anxiety can result in poorer ART adherence.

Experiences of Adolescents on Antiretroviral Therapy at Rustenburg Sub-District, Northwest Province, South Africa

BACKGROUND

Antiretroviral therapy (ART) is the treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs. The standard treatment consists of a combination of drugs (often called highly active antiretroviral therapy or HAART) that suppress HIV replication. As a result, people who have been infected live longer while on ART, which was initiated in South Africa in 2004.

AIM

The study aimed to explore the experiences of adolescents on antiretroviral therapy in two primary health care clinics in Rustenburg sub-district Northwest Province.

METHODS

Qualitative, explorative, descriptive, and contextual approaches were adopted. Non-probability purposive sampling was used to select the healthcare facilities, and adolescents were chosen using convenience sampling. In-depth individual interviews were used to collect data from the participants. Only 13 adolescents between the ages of 15 and 19 years were interviewed. Collected data were analyzed using Tesch's eight steps.

RESULTS

Qualitative themes identified included a description of the experiences of adolescents living HIV to adulthood and challenges experienced from childhood to adolescence period. Each theme had different sub-themes which included the paradoxical experiences of being diagnosed with HIV and being on antiretroviral treatment. Adolescents experienced poor adherence to ART due to treatment side effects such as drowsiness, change in body image, and headaches. Self-stigma resulted in adolescents not disclosing their status to their peers, closest and sexual partners which also made them not to adhere well in treatment.

CONCLUSIONS

The study findings revealed that HIV-positive adolescents encounter various experiences while on ART, which causes them not to adhere to treatment. In the study, adolescents also experienced self-stigma which also affected their treatment adherence and brought fear of losing their loved ones.